Integrating heterogeneous databases in clustered medic care environments using object-oriented technology

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Thakore, Arun K.; Sauer, Frank

1994-05-01

The organization of modern medical care environments into disease-related clusters, such as a cancer center, a diabetes clinic, etc., has the side-effect of introducing multiple heterogeneous databases, often containing similar information, within the same organization. This heterogeneity fosters incompatibility and prevents the effective sharing of data amongst applications at different sites. Although integration of heterogeneous databases is now feasible, in the medical arena this is often an ad hoc process, not founded on proven database technology or formal methods. In this paper we illustrate the use of a high-level object- oriented semantic association method to model information found in different databases into an integrated conceptual global model that integrates the databases. We provide examples from the medical domain to illustrate an integration approach resulting in a consistent global view, without attacking the autonomy of the underlying databases.

Emphasizing humanities in medical education: Promoting the integration of medical scientific spirit and medical humanistic spirit.

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Song, Peipei; Tang, Wei

2017-05-23

In the era of the biological-psychological-social medicine model, an ideal of modern medicine is to enhance the humanities in medical education, to foster medical talents with humanistic spirit, and to promote the integration of scientific spirit and humanistic spirit in medicine. Throughout the United States (US), United Kingdom (UK), other Western countries, and some Asian countries like Japan, many medical universities have already integrated the learning of medical humanities in their curricula and recognized their value. While in China, although medical education reform over the past decade has emphasized the topic of medical humanities to increase the professionalism of future physicians, the integration of medical humanity courses in medical universities has lagged behind the pace in Western countries. In addition, current courses in medical humanities were arbitrarily established due to a lack of organizational independence. For various reasons like a shortage of instructors, medical universities have failed to pay sufficient attention to medical humanities education given the urgent needs of society. The medical problems in contemporary Chinese society are not solely the purview of biomedical technology; what matters more is enhancing the humanities in medical education and fostering medical talents with humanistic spirit. Emphasizing the humanities in medical education and promoting the integration of medical scientific spirit and medical humanistic spirit have become one of the most pressing issues China must address. Greater attention should be paid to reasonable integration of humanities into the medical curriculum, creation of medical courses related to humanities and optimization of the curriculum, and actively allocating abundant teaching resources and exploring better methods of instruction.

Integration Platform As Central Service Of Data Replication In Distributed Medical System

Directory of Open Access Journals (Sweden)

Wiesław Wajs

2007-01-01

Full Text Available The paper presents the application of Java Integration Platform (JIP to data replicationin the distributed medical system. After an introductory part on the medical system’s architecture,the focus shifts to a comparison of different approaches that exist with regard totransferring data between the system’s components. A description is given of the historicaldata processing and of the whole area of the JIP application to the medical system.

Medical Device Integrated Vital Signs Monitoring Application with Real-Time Clinical Decision Support.

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Moqeem, Aasia; Baig, Mirza; Gholamhosseini, Hamid; Mirza, Farhaan; Lindén, Maria

2018-01-01

This research involves the design and development of a novel Android smartphone application for real-time vital signs monitoring and decision support. The proposed application integrates market available, wireless and Bluetooth connected medical devices for collecting vital signs. The medical device data collected by the app includes heart rate, oxygen saturation and electrocardiograph (ECG). The collated data is streamed/displayed on the smartphone in real-time. This application was designed by adopting six screens approach (6S) mobile development framework and focused on user-centered approach and considered clinicians-as-a-user. The clinical engagement, consultations, feedback and usability of the application in the everyday practices were considered critical from the initial phase of the design and development. Furthermore, the proposed application is capable to deliver rich clinical decision support in real-time using the integrated medical device data.

Closed-loop approach for situation awareness of medical devices and operating room infrastructure

Directory of Open Access Journals (Sweden)

Rockstroh Max

2015-09-01

Full Text Available In recent years, approaches for information and control integration in the digital operating room have emerged. A major step towards an intelligent operating room and a cooperative technical environment would be autonomous adaptation of medical devices and systems to the surgical workflow. The OR staff should be freed from information seeking and maintenance tasks. We propose a closed-loop concept integrating workflow monitoring, processing and (semi-automatic interaction to bridge the gap between OR integration of medical devices and workflow-related information management.

Does the integration of TB medical services in the general hospital improve the quality of TB care? Evidence from a case study in China.

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Sun, Qiang; Yin, Jia; Yin, Xiao; Zou, Guanyang; Liang, Mingli; Zhong, Jieming; Walley, John; Wei, Xiaolin

2013-06-01

Moving the clinical services from tuberculosis (TB) dispensary to the integrated county hospital (called integrated approach) has been practiced in China; however, it is unknown the quality of TB care in the integrated approach and in the dispensary approach. A total of 202 new TB patients were investigated using structured questionnaires in three counties implementing the integrated approach and one county implementing the dispensary approach. The quality of TB care is measured based on success rate of treatment, medical expenditure, health system delay and second-line drug use. The integrated approach showed a high success treatment rate. The medical expenditure in the integrated approach was USD 432, significantly lower than that in the dispensary approach (Z = -5.771, P < 0.001). The integrated approach had a shorter health system delay (5 days) than the dispensary approach (32 days). Twenty-six percent of patients in integrated hospitals were prescribed with second-line TB drugs, significantly lower than that in the TB dispensary (47%, χ(2) = 7.452, P = 0.006). However, the medical expenditure, use of second-line anti-TB drug and liver-protection drugs indeed varied greatly across the three integrated hospitals. The integrated approach showed better quality of TB care, but the performance of the integrated hospitals varied greatly. A method to standardize TB treatment and management of this approach is urgent.

Thinking about thinking and emotion: the metacognitive approach to the medical humanities that integrates the humanities with the basic and clinical sciences.

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Eichbaum, Quentin G

2014-01-01

Medical knowledge in recent decades has grown prodigiously and has outstripped the capacity of the human brain to absorb and understand it all. This burgeoning of knowledge has created a dilemma for medical educators. We can no longer expect students to continue memorizing this large body of increasingly complex knowledge. Instead, our efforts should be redirected at developing in students a competency as flexible thinkers and agile learners so they can adeptly deal with new knowledge, complexity, and uncertainty in a rapidly changing world. Such a competency would entail not only cognitive but also emotional skills essential for the holistic development of their professional identity. This article will argue that metacognition--“thinking about thinking (and emotion)”--offers the most viable path toward developing this competency. The overwhelming volume of medical knowledge has driven some medical schools to reduce the time allocated in their curricula to the “soft-option” humanities as they tend to consider them an expendable “luxury.” Vanderbilt University School of Medicine, Nashville, TN, has moved away from the traditional conception of the medical humanities as “the arts,” composed of art, music, and literature, toward an approach that integrates the humanities with the basic and clinical sciences, based on metacognition. This metacognitive approach to the humanities, described in this article, has three goals: 1) to develop students as flexible thinkers and agile learners and to provide them with essential cognitive and emotional skills for navigating medical complexity and uncertainty; 2) to elicit in students empathy and tolerance by making them aware of the immense diversity in human cognition (and emotion); and 3) to integrate the humanities with the basic and clinical sciences. Through this metacognitive approach, students come to understand their patterns of cognition and emotions, and in the group setting, they learn to mindfully

XML-based approaches for the integration of heterogeneous bio-molecular data.

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Mesiti, Marco; Jiménez-Ruiz, Ernesto; Sanz, Ismael; Berlanga-Llavori, Rafael; Perlasca, Paolo; Valentini, Giorgio; Manset, David

2009-10-15

The today's public database infrastructure spans a very large collection of heterogeneous biological data, opening new opportunities for molecular biology, bio-medical and bioinformatics research, but raising also new problems for their integration and computational processing. In this paper we survey the most interesting and novel approaches for the representation, integration and management of different kinds of biological data by exploiting XML and the related recommendations and approaches. Moreover, we present new and interesting cutting edge approaches for the appropriate management of heterogeneous biological data represented through XML. XML has succeeded in the integration of heterogeneous biomolecular information, and has established itself as the syntactic glue for biological data sources. Nevertheless, a large variety of XML-based data formats have been proposed, thus resulting in a difficult effective integration of bioinformatics data schemes. The adoption of a few semantic-rich standard formats is urgent to achieve a seamless integration of the current biological resources.

[Research on medical instrument information integration technology based on IHE PCD].

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Zheng, Jianli; Liao, Yun; Yang, Yongyong

2014-06-01

Integrating medical instruments with medical information systems becomes more and more important in healthcare industry. To make medical instruments without standard communication interface possess the capability of interoperating and sharing information with medical information systems, we developed a medical instrument integration gateway based on Integrating the Healthcare Enterprise Patient Care Device (IHE PCD) integration profiles in this research. The core component is an integration engine which is implemented according to integration profiles and Health Level Seven (HL7) messages defined in IHE PCD. Working with instrument specific Javascripts, the engine transforms medical instrument data into HL7 ORU message. This research enables medical instruments to interoperate and exchange medical data with information systems in a standardized way, and is valuable for medical instrument integration, especially for traditional instruments.

Integrating surgical robots into the next medical toolkit.

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Lai, Fuji; Entin, Eileen

2006-01-01

Surgical robots hold much promise for revolutionizing the field of surgery and improving surgical care. However, despite the potential advantages they offer, there are multiple barriers to adoption and integration into practice that may prevent these systems from realizing their full potential benefit. This study elucidated some of the most salient considerations that need to be addressed for integration of new technologies such as robotic systems into the operating room of the future as it evolves into a complex system of systems. We conducted in-depth interviews with operating room team members and other stakeholders to identify potential barriers in areas of workflow, teamwork, training, clinical acceptance, and human-system interaction. The findings of this study will inform an approach for the design and integration of robotics and related computer-assisted technologies into the next medical toolkit for "computer-enhanced surgery" to improve patient safety and healthcare quality.

Towards an integrated approach in supporting microbiological food safety decisions

DEFF Research Database (Denmark)

Havelaar, A.H.; Braunig, J.; Christiansen, K.

2007-01-01

an integrated scientific approach combining veterinary and medical epidemiology, risk assessment for the farm-to-fork food chain as well as agricultural and health economy. Scientific advice is relevant in all stages of the policy cycle: to assess the magnitude of the food safety problem, to define...

New paradigm of the medical audit: multidisciplinary or transdisciplinary approaches?

Directory of Open Access Journals (Sweden)

V. S. Biryukov

2017-06-01

Full Text Available The study is devoted to formation a new paradigm in relation the essence of medical audit. Using the example of requirements international quality standards ISO 90001: 2015 and GCP, it is shown that disciplinary and multidisciplinary approaches are progressive steps in implementing the quality policy in medical services, but they are unable to overcome the fundamental drawback - fragmentation the system. Thus, the audit quality management system in health care institution, in accordance with the ISO 9001 standard, does not allow assessing the quality of procedures performed by medical personnel, the adequacy of diagnostic and therapeutic actions in relation to nosological units, the comparative efficiency and effectiveness methods of treatment and diagnostics used. In its turn, the clinical audit by GCP standard is not able to detect defects work of support services, various risks accompanying medical activities, reveal the degree of patient satisfaction with medical services and provide evidence of economic viability to partners. Economic audit, in turn, is not able to give an idea of competence level of management and medical personnel in medical institution. A more complete picture activity a medical institution can be obtained through a medical audit involving an interdisciplinary approach in which a new system-forming concept is formed on the basis of integration data from various disciplinary methods.

Integrated care: wellness-oriented peer approaches: a key ingredient for integrated care.

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Swarbrick, Margaret A

2013-08-01

People with lived experience of mental illness have become leaders of an influential movement to help the mental health system embrace the notion of whole health and wellness in the areas of advocacy, policy, and care delivery. Wellness-oriented peer approaches delivered by peer-support whole-health specialists and wellness coaches can play an important role in integrated care models. This column examines the wellness definitions and peer models and some specific benefits and tensions between the peer-oriented wellness approach and the medical model. These models can work in unison to improve health and wellness among people with mental and substance use disorders.

Vertical integration of medical education: Riverland experience, South Australia.

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Rosenthal, D R; Worley, P S; Mugford, B; Stagg, P

2004-01-01

Vertical integration of medical education is currently a prominent international topic, resulting from recent strategic initiatives to improve medical education and service delivery in areas of poorly met medical need. In this article, vertical integration of medical education is defined as 'a grouping of curricular content and delivery mechanisms, traversing the traditional boundaries of undergraduate, postgraduate and continuing medical education, with the intent of enhancing the transfer of knowledge and skills between those involved in the learning-teaching process'. Educators closely involved with vertically integrated teaching in the Riverland of South Australia present an analytical description of the educational dynamics of this system. From this analysis, five elements are identified which underpin the process of successful vertical integration: (1) raised educational stakes; (2) local ownership; (3) broad university role; (4) longer attachments; and (5) shared workforce vision. Given the benefits to the Riverland medical education programs described in this paper, it is not surprising that vertical integration of medical education is a popular goal in many rural regions throughout the world. Although different contexts will result in different functional arrangements, it could be argued that the five principles outlined in this article can be applied in any region.

Assessment of Medical Risks and Optimization of their Management using Integrated Medical Model

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Fitts, Mary A.; Madurai, Siram; Butler, Doug; Kerstman, Eric; Risin, Diana

2008-01-01

The Integrated Medical Model (IMM) Project is a software-based technique that will identify and quantify the medical needs and health risks of exploration crew members during space flight and evaluate the effectiveness of potential mitigation strategies. The IMM Project employs an evidence-based approach that will quantify probability and consequences of defined in-flight medical risks, mitigation strategies, and tactics to optimize crew member health. Using stochastic techniques, the IMM will ultimately inform decision makers at both programmatic and institutional levels and will enable objective assessment of crew health and optimization of mission success using data from relevant cohort populations and from the astronaut population. The objectives of the project include: 1) identification and documentation of conditions that may occur during exploration missions (Baseline Medical Conditions List [BMCL), 2) assessment of the likelihood of conditions in the BMCL occurring during exploration missions (incidence rate), 3) determination of the risk associated with these conditions and quantify in terms of end states (Loss of Crew, Loss of Mission, Evacuation), 4) optimization of in-flight hardware mass, volume, power, bandwidth and cost for a given level of risk or uncertainty, and .. validation of the methodologies used.

Integration of foreign and local medical staff in a disaster area: the Honduras and El Salvador experiences.

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Waisman, Yehezkel

2003-06-01

International medical aid after natural disasters may take various forms, ranging from self-sufficient military forces to single experts or specialists who function primarily as advisers. A model integrating foreign and local medical staff has not previously been reported. In response to the call for international aid by the Honduran and El Salvadorian governments in the wake of Hurricane Mitch in November 1998 and the San Salvador earthquake in January 2001, Israel sent medical supplies and 10 member teams of medical professionals to each country. The aim of the present paper is to describe the unique Israeli approach to providing healthcare in disaster areas by integrating foreign and local medical staff, and to discuss its advantages and disadvantages. The paper focuses on the experience of the two emergency medicine physicians on the team who were assigned to the Atlantida General Hospital in La Ceiba, Honduras. The same team in San Salvador subsequently applied the same approach.

A framework for integration of heterogeneous medical imaging networks.

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Viana-Ferreira, Carlos; Ribeiro, Luís S; Costa, Carlos

2014-01-01

Medical imaging is increasing its importance in matters of medical diagnosis and in treatment support. Much is due to computers that have revolutionized medical imaging not only in acquisition process but also in the way it is visualized, stored, exchanged and managed. Picture Archiving and Communication Systems (PACS) is an example of how medical imaging takes advantage of computers. To solve problems of interoperability of PACS and medical imaging equipment, the Digital Imaging and Communications in Medicine (DICOM) standard was defined and widely implemented in current solutions. More recently, the need to exchange medical data between distinct institutions resulted in Integrating the Healthcare Enterprise (IHE) initiative that contains a content profile especially conceived for medical imaging exchange: Cross Enterprise Document Sharing for imaging (XDS-i). Moreover, due to application requirements, many solutions developed private networks to support their services. For instance, some applications support enhanced query and retrieve over DICOM objects metadata. This paper proposes anintegration framework to medical imaging networks that provides protocols interoperability and data federation services. It is an extensible plugin system that supports standard approaches (DICOM and XDS-I), but is also capable of supporting private protocols. The framework is being used in the Dicoogle Open Source PACS.

Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

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Christensen, Leif; Karle, Hans; Nystrup, Jørgen

2007-09-01

An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

Back to the basic sciences: an innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine.

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Spencer, Abby L; Brosenitsch, Teresa; Levine, Arthur S; Kanter, Steven L

2008-07-01

Abraham Flexner persuaded the medical establishment of his time that teaching the sciences, from basic to clinical, should be a critical component of the medical student curriculum, thus giving rise to the "preclinical curriculum." However, students' retention of basic science material after the preclinical years is generally poor. The authors believe that revisiting the basic sciences in the fourth year can enhance understanding of clinical medicine and further students' understanding of how the two fields integrate. With this in mind, a return to the basic sciences during the fourth year of medical school may be highly beneficial. The purpose of this article is to (1) discuss efforts to integrate basic science into the clinical years of medical student education throughout the United States and Canada, and (2) describe the highly developed fourth-year basic science integration program at the University of Pittsburgh School of Medicine. In their critical review of medical school curricula of 126 U.S. and 17 Canadian medical schools, the authors found that only 19% of U.S. medical schools and 24% of Canadian medical schools require basic science courses or experiences during the clinical years, a minor increase compared with 1985. Curricular methods ranged from simple lectures to integrated case studies with hands-on laboratory experience. The authors hope to advance the national discussion about the need to more fully integrate basic science teaching throughout all four years of the medical student curriculum by placing a curricular innovation in the context of similar efforts by other U.S. and Canadian medical schools.

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

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Fragidis, Leonidas L; Chatzoglou, Prodromos D; Aggelidis, Vassilios P

2016-11-14

The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

Integrated medication management in mHealth applications.

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Ebner, Hubert; Modre-Osprian, Robert; Kastner, Peter; Schreier, Günter

2014-01-01

Continuous medication monitoring is essential for successful management of heart failure patients. Experiences with the recently established heart failure network HerzMobil Tirol show that medication monitoring limited to heart failure specific drugs could be insufficient, in particular for general practitioners. Additionally, some patients are confused about monitoring only part of their prescribed drugs. Sometimes medication will be changed without informing the responsible physician. As part of the upcoming Austrian electronic health record system ELGA, the eMedication system will collect prescription and dispensing data of drugs and these data will be accessible to authorized healthcare professionals on an inter-institutional level. Therefore, we propose two concepts on integrated medication management in mHealth applications that integrate ELGA eMedication and closed-loop mHealth-based telemonitoring. As a next step, we will implement these concepts and analyze--in a feasibility study--usability and practicability as well as legal aspects with respect to automatic data transfer from the ELGA eMedication service.

On-line integration of computer controlled diagnostic devices and medical information systems in undergraduate medical physics education for physicians.

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Hanus, Josef; Nosek, Tomas; Zahora, Jiri; Bezrouk, Ales; Masin, Vladimir

2013-01-01

We designed and evaluated an innovative computer-aided-learning environment based on the on-line integration of computer controlled medical diagnostic devices and a medical information system for use in the preclinical medical physics education of medical students. Our learning system simulates the actual clinical environment in a hospital or primary care unit. It uses a commercial medical information system for on-line storage and processing of clinical type data acquired during physics laboratory classes. Every student adopts two roles, the role of 'patient' and the role of 'physician'. As a 'physician' the student operates the medical devices to clinically assess 'patient' colleagues and records all results in an electronic 'patient' record. We also introduced an innovative approach to the use of supportive education materials, based on the methods of adaptive e-learning. A survey of student feedback is included and statistically evaluated. The results from the student feedback confirm the positive response of the latter to this novel implementation of medical physics and informatics in preclinical education. This approach not only significantly improves learning of medical physics and informatics skills but has the added advantage that it facilitates students' transition from preclinical to clinical subjects. Copyright © 2011 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Communication Skills in Medical Education: An Integrated Approach

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Bennett, Kellie; Lyons, Zaza

2011-01-01

The importance of teaching communication skills in any undergraduate medical curriculum cannot be overstated. Effective doctor-patient communication is widely recognised as an essential aspect of quality patient care. A communication skills module developed for first year medical students at the University of Western Australia (UWA) is described…

Integrated Medical Model Project - Overview and Summary of Historical Application

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Myers, J.; Boley, L.; Butler, D.; Foy, M.; Goodenow, D.; Griffin, D.; Keenan, A.; Kerstman, E.; Melton, S.; McGuire, K.;

Integration testing through reusing representative unit test cases for high-confidence medical software.

Science.gov (United States)

Shin, Youngsul; Choi, Yunja; Lee, Woo Jin

2013-06-01

As medical software is getting larger-sized, complex, and connected with other devices, finding faults in integrated software modules gets more difficult and time consuming. Existing integration testing typically takes a black-box approach, which treats the target software as a black box and selects test cases without considering internal behavior of each software module. Though it could be cost-effective, this black-box approach cannot thoroughly test interaction behavior among integrated modules and might leave critical faults undetected, which should not happen in safety-critical systems such as medical software. This work anticipates that information on internal behavior is necessary even for integration testing to define thorough test cases for critical software and proposes a new integration testing method by reusing test cases used for unit testing. The goal is to provide a cost-effective method to detect subtle interaction faults at the integration testing phase by reusing the knowledge obtained from unit testing phase. The suggested approach notes that the test cases for the unit testing include knowledge on internal behavior of each unit and extracts test cases for the integration testing from the test cases for the unit testing for a given test criteria. The extracted representative test cases are connected with functions under test using the state domain and a single test sequence to cover the test cases is produced. By means of reusing unit test cases, the tester has effective test cases to examine diverse execution paths and find interaction faults without analyzing complex modules. The produced test sequence can have test coverage as high as the unit testing coverage and its length is close to the length of optimal test sequences. Copyright © 2013 Elsevier Ltd. All rights reserved.

78 FR 27343 - Medical Examiner's Certification Integration

Science.gov (United States)

2013-05-10

... efficiency; (2) reflect current medical terminology and examination components; and (3) be a self-contained... 391 [Docket No. FMCSA-2012-0178] RIN 2126-AB40 Medical Examiner's Certification Integration AGENCY...: FMCSA proposes to require certified medical examiners (MEs) performing physical examinations on drivers...

Development of an integrated medical supply information system

Science.gov (United States)

Xu, Eric; Wermus, Marek; Blythe Bauman, Deborah

2011-08-01

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.

Integrated Medical Model – Chest Injury Model

Data.gov (United States)

National Aeronautics and Space Administration — The Exploration Medical Capability (ExMC) Element of NASA's Human Research Program (HRP) developed the Integrated Medical Model (IMM) to forecast the resources...

Evaluation of a teaching strategy based on integration of clinical subjects, virtual autopsy, pathology museum, and digital microscopy for medical students.

Science.gov (United States)

Diaz-Perez, Julio A; Raju, Sharat; Echeverri, Jorge H

2014-01-01

Learning pathology is fundamental for a successful medical practice. In recent years, medical education has undergone a profound transformation toward the development of an integrated curriculum incorporating both basic science and clinical material. Simultaneously, there has been a shift from a magisterial teaching approach to one centered around problem-based learning. Now-a-days, informatics tools are expected to help better implement these strategies. We applied and evaluated a new teaching method based on an active combination of clinical problems, gross pathology, histopathology, and autopsy pathology, all given through informatics tools, to teach a group of medical students at the Universidad de Santander, Colombia. Ninety-four medical students were followed in two consecutive semesters. Students were randomized to receive teaching either through traditional methodology or through the new integrated approach. There was no significant difference between the intervention group and the control group at baseline. At the end of the study, the scores in the intervention group were significantly higher compared to the control group (3.91/5.0 vs. 3.33/5.0, P = 0.0008). Students and tutors endorsed the benefits of the integrated approach. Participants were very satisfied with this training approach and rated the program an 8.7 out of 10, on average. This study confirms that an integrated curriculum utilizing informatics systems provides an excellent opportunity to associate pathology with clinical medicine early in training of medical students. This can be possible with the use of virtual microscopy and digital imaging.

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

Science.gov (United States)

Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

2009-01-01

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

Science.gov (United States)

Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

2017-04-01

Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

Integrated software system for improving medical equipment management.

Science.gov (United States)

Bliznakov, Z; Pappous, G; Bliznakova, K; Pallikarakis, N

2003-01-01

The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot

Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

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Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

2015-01-01

Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

An integrative review of the literature on registered nurses' medication competence.

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Sulosaari, Virpi; Suhonen, Riitta; Leino-Kilpi, Helena

2011-02-01

The aim of this integrative literature review was to describe registered nurses' medication competence. The objectives of the literature review were to chart the need for future studies and use the results for instrument development. Nurses play a vital role in different phases of a patient's medication process and thus need adequate competence to fulfil their role. Research on nurses' level of medication competence in different competency areas has been published. However, previous studies have lacked a comprehensive or integrated definition or description of medication competence in nursing. Integrative literature review. The integrative literature review followed five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation. Eligible articles were identified via systematic literature search of research and evidence-based--databases. Twenty-one studies met the selection criteria. Eleven competency areas that constitute nurses' medication competence were identified: (1) anatomy and physiology, (2) pharmacology, (3) communication, (4) interdisciplinary collaboration, (5) information seeking, (6) mathematical and medication calculation, (7) medication administration, (8) medication education, (9) assessment and evaluation, (10) documentation and (11) promoting medication safety as part of patient safety. The analysis revealed three major categories which integrate these competency areas: (1) decision making competence, (2) theoretical competence and (3) practical competence. Medication competence requires a solid knowledge base and the ability to apply that knowledge in real-life situations during often complex and dynamic patient medication processes. Decision making competence was found to be an important and integral part of a nurses' theoretical and practical competence. These main competence categories integrated all of the 11 competency areas identified in this review. It is important to determine

Influence of national culture on the adoption of integrated medical curricula.

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Jippes, Mariëlle; Majoor, Gerard D

2011-03-01

Integrated curricula have been implemented in medical schools all over the world. However, among countries different relative numbers of schools with integrated curricula are found. This study aims to explore the possible correlation between the percentage of medical schools with integrated curricula in a country and that country's cultural characteristics. Curricula were defined as not integrated if in the first 2 years of the program at least two out of the three monodisciplinary courses Anatomy, Physiology and Biochemistry were identified. Culture was defined using Hofstede's dimensions Power distance, Uncertainty avoidance, Masculinity/Femininity, and Individualism/Collectivism. Consequently, this study had to be restricted to the 63 countries included in Hofstede's studies which harbored 1,195 medical schools. From each country we randomly sampled a maximum of 15 schools yielding 484 schools to be investigated. In total 91% (446) of the curricula were found. Correlation of percent integrated curricula and each dimension of culture was determined by calculating Spearman's Rho. A high score on the Power distance index and a high score on the Uncertainty avoidance index correlated with a low percent integrated curricula; a high score on the Individualism index correlated with a high percent integrated curricula. The percentage integrated curricula in a country did not correlate with its score on the Masculinity index. National culture is associated with the propensity of medical schools to adopt integrated medical curricula. Consequently, medical schools considering introduction of integrated and problem-based medical curricula should take into account dimensions of national culture which may hinder the innovation process.

QUANTITATIVE СHARACTERISTICS OF COMPLEMENTARY INTEGRATED HEALTH CARE SYSTEM AND INTEGRATED MEDICATION MANAGEMENT INFORMATION SYSTEM

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L. Yu. Babintseva

2015-05-01

i mportant elements of state regulation of the pharmaceutical sector health. For the first time creation of two information systems: integrated medication management infor mation system and integrated health care system in an integrated medical infor mation area, operating based on th e principle of complementarity was justified. Global and technological coefficients of these systems’ functioning were introduced.

Integration of Computers into the Medical School Curriculum: An Example from a Microbiology Course.

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Platt, Mark W.; And Others

1994-01-01

While the use of computers has become widespread in recent years, a unified, integrated approach to their use in the medical school curriculum has not yet emerged. Describes a program at the University of New Mexico that will phase-in computerization of its curriculum beginning in the fall of 1993. (LZ)

Integrating Parenting Support Within and Beyond the Pediatric Medical Home.

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Linton, Julie M; Stockton, Maria Paz; Andrade, Berta; Daniel, Stephanie

2018-01-01

Positive parenting programs, developmental support services, and evidence-based home visiting programs can effectively provide parenting support and improve health and developmental outcomes for at-risk children. Few models, however, have integrated referrals for on-site support and home visiting programs into the provision of routine pediatric care within a medical home. This article describes an innovative approach, through partnership with a community-based organization, to deliver on-site and home visiting support services for children and families within and beyond the medical home. Our model offers a system of on-site services, including parenting, behavior, and/or development support, with optional intensive home visiting services. Assessment included description of the population served, delineation of services provided, and qualitative identification of key themes of the impact of services, illustrated by case examples. This replicable model describes untapped potential of the pediatric medical home as a springboard to mitigate risk and optimize children's health and development.

Incorporation of integrative medicine education into undergraduate medical education: a longitudinal study

Institute of Scientific and Technical Information of China (English)

Saswati Mahapatra; Anjali Bhagra; Bisrat Fekadu; Zhuo Li; Brent A.Bauer; Dietlind L.Wahner-Roedler

2017-01-01

OBJECTIVE:Integrative medicine (IM) combines complementary medical approaches into conventional medicine and considers the whole person.We implemented a longitudinal IM short-course curriculum into our medical school education.This study aimed to evaluate the feasibility and effectiveness of the curriculum via knowledge and attitude surveys regarding IM among students.METHODS:A mandatory short IM curriculum across all years of medical school was created and taught by IM professionals and physician faculty members with expertise in integrative therapies.Graduating classes of 2015 and 2016 completed the same survey in their first and third years of medical school.Paired data analysis was done,and only students who completed surveys at both time points were included in final analyses.RESULTS:Of 52 students in each class,17 (33％) in the class of 2015 and 22 (42％) in the class of 2016 completed both surveys.After the IM curriculum,students' knowledge of and comfort with several IM therapies—biofeedback,mindfulness,and the use of St.John's wort—improved significantly.Students' personal health practices also improved,including better sleep,exercise,and stress management for the class of 2015.Students graduating in 2016 reported decreased alcohol use in their third year compared with their first year.CONCLUSION:It is feasible to incorporate IM education into undergraduate medical education,and this is associated with improvement in students' knowledge of IM and personal health practices.

Climate change: what competencies and which medical education and training approaches?

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Bell Erica J

2010-04-01

Full Text Available Abstract Background Much research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change. Discussion The paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training. Summary The health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Human Space Flight Missions

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Kerstman, Eric L.; Minard, Charles; FreiredeCarvalho, Mary H.; Walton, Marlei E.; Myers, Jerry G., Jr.; Saile, Lynn G.; Lopez, Vilma; Butler, Douglas J.; Johnson-Throop, Kathy A.

2011-01-01

This slide presentation reviews the Integrated Medical Model (IMM) and its use as a risk assessment and decision support tool for human space flight missions. The IMM is an integrated, quantified, evidence-based decision support tool useful to NASA crew health and mission planners. It is intended to assist in optimizing crew health, safety and mission success within the constraints of the space flight environment for in-flight operations. It uses ISS data to assist in planning for the Exploration Program and it is not intended to assist in post flight research. The IMM was used to update Probability Risk Assessment (PRA) for the purpose of updating forecasts for the conditions requiring evacuation (EVAC) or Loss of Crew Life (LOC) for the ISS. The IMM validation approach includes comparison with actual events and involves both qualitative and quantitaive approaches. The results of these comparisons are reviewed. Another use of the IMM is to optimize the medical kits taking into consideration the specific mission and the crew profile. An example of the use of the IMM to optimize the medical kits is reviewed.

Structural characterisation of medically relevant protein assemblies by integrating mass spectrometry with computational modelling.

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Politis, Argyris; Schmidt, Carla

2018-03-20

Structural mass spectrometry with its various techniques is a powerful tool for the structural elucidation of medically relevant protein assemblies. It delivers information on the composition, stoichiometries, interactions and topologies of these assemblies. Most importantly it can deal with heterogeneous mixtures and assemblies which makes it universal among the conventional structural techniques. In this review we summarise recent advances and challenges in structural mass spectrometric techniques. We describe how the combination of the different mass spectrometry-based methods with computational strategies enable structural models at molecular levels of resolution. These models hold significant potential for helping us in characterizing the function of protein assemblies related to human health and disease. In this review we summarise the techniques of structural mass spectrometry often applied when studying protein-ligand complexes. We exemplify these techniques through recent examples from literature that helped in the understanding of medically relevant protein assemblies. We further provide a detailed introduction into various computational approaches that can be integrated with these mass spectrometric techniques. Last but not least we discuss case studies that integrated mass spectrometry and computational modelling approaches and yielded models of medically important protein assembly states such as fibrils and amyloids. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

[Humanities in medical education: between reduction and integration].

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Han, Taehee

2015-09-01

Reductive logic has been a major reasoning style in development of modern biomedical sciences. However, when "medical humanities" is developed by reductive reasoning, integrative and holistic values of humanities tend to be weakened. In that sense, identity and significance of "medical humanities" continue to be controversial despite of its literal clarity. Humanities in medical education should be established by strengthening humanistic and socialistic aspects of regular medical curriculum as well as developing individual "medical humanities" programs.

Integrating the results of user research into medical device development: insights from a case study.

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Martin, Jennifer L; Barnett, Julie

2012-07-19

It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision making processes may assist manufacturers to take a more integrated and

Integrating the results of user research into medical device development: insights from a case study

Directory of Open Access Journals (Sweden)

Martin Jennifer L

2012-07-01

Full Text Available Abstract Background It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. Methods A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. Results A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. Conclusion There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision

Extended device profiles and testing procedures for the approval process of integrated medical devices using the IEEE 11073 communication standard.

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Janß, Armin; Thorn, Johannes; Schmitz, Malte; Mildner, Alexander; Dell'Anna-Pudlik, Jasmin; Leucker, Martin; Radermacher, Klaus

2018-02-23

Nowadays, only closed and proprietary integrated operating room systems (IORS) from big manufacturers are available on the market. Hence, the interconnection of components from third-party vendors is only possible with increased time and costs. In the context of the German Federal Ministry of Education and Research (BMBF)-funded project OR.NET (2012-2016), the open integration of medical devices from different manufacturers was addressed. An integrated operating theater based on the open communication standard IEEE 11073 shall give clinical operators the opportunity to choose medical devices independently of the manufacturer. This approach would be advantageous especially for hospital operators and small- and medium-sized enterprises (SME) of medical devices. Actual standards and concepts regarding technical feasibility and the approval process do not cope with the requirements for a modular integration of medical devices in the operating room (OR), based on an open communication standard. Therefore, innovative approval strategies and corresponding certification and test procedures, which cover actual legal and normative standards, have to be developed in order to support the future risk management and the usability engineering process of open integrated medical devices in the OR. The use of standardized device and service profiles and a three-step testing procedure, including conformity, interoperability and integration tests are described in this paper and shall support the manufacturers to integrate their medical devices without disclosing the medical devices' risk analysis and related confidential expertise or proprietary information.

Towards an integrated management of health physics and medical physics

International Nuclear Information System (INIS)

Mommaert, Chantal; Rogge, Frank; Cortenbosch, Geert; Schmitz, Frederic

2007-01-01

AVN is a licensed body that performs health physics control in different types of installations, from large nuclear facilities to small dentist cabinets. AVN can also provide medical physics services for the quality control of, for instance, medical devices used in a radiology or nuclear medicine department. Radiation protection for personnel and environment (health physics) and radiation protection for the patient (medical physics) are usually treated separately, using different referential documents, such as the European Directives 96/29/Euratom for health physics and 97/43/Euratom for medical physics. This difference is also clearly reflected in the Belgium legislation (two types of accreditation/licence for inspectors, different chapters in the law,..) From a practical point of view it is sometimes rather difficult to split the task 'on site' during an inspection. An RX system not complying with radiation protection criteria can definitively affect the patient as well as the workers. On the other hand, the hospitals, cannot easily differentiate these two tasks because they are not fully aware of the legislation and they are mixing both. Taking into account the health physics guidelines as well as medical physics guidelines, we have decided to move to an integrated approach of these two concepts. (orig.)

Integration of Cognitive Skills as a Cross-Cutting Theme Into the Undergraduate Medical Curriculum at Tehran University of Medical Sciences

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Akbar Soltani

2017-02-01

Full Text Available Nowadays, improvement of thinking skills of students is one of the universally supported aims in the majority of medical schools. This study aims to design longitudinal theme of reasoning, problem-solving and decision-making into the undergraduate medical curriculum at Tehran University of Medical Sciences (TUMS. A participatory approach was applied to design the curriculum during 2009-2011. The project was conducted by the contribution of representatives of both basic and clinical faculty members, students and graduates at Tehran University of Medical Sciences. The first step toward integrating cognitive skills into the curriculum was to assemble a taskforce of different faculty and students, including a wide variety of fields with multidisciplinary expertise using nonprobability sampling and the snowball method. Several meetings with the contribution of experts and some medical students were held to generate the draft of expected outcomes. Subsequently, the taskforce also determined what content would fit best into each phase of the program and what teaching and assessment methods would be more appropriate for each outcome. After a pilot curriculum with a small group of second-year medical students, we implemented this program for all first-year students since 2011 at TUMS. Based on findings, the teaching of four areas, including scientific and critical thinking skills (Basic sciences, problem-solving and reasoning (Pathophysiology, evidence-based medicine (Clerkship, and clinical decision-making (Internship were considered in the form of a longitudinal theme. The results of this study could be utilized as a useful pattern for integration of psycho-social subjects into the medical curriculum.

Introduction of an integrated interactive lecture in the early blocks of 1st year medical students: A pilot study

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Anudeep Singh

2016-01-01

Full Text Available Background: In an integrated curriculum, topics are integrated at the system block level from semester 2 onward. However, in the basic biomedical block, opportunities to integrate also exist which is often overlooked. Aim: A study was conducted to determine the possibility and acceptability of a new pedagogical approach to aid integration of form and function along with the improvement of understanding. Materials and Design: The study was prospective and questionnaire-based, conducted in an upcoming medical college in Malaysia with 1st year medical students. Materials and Methods: An integrated lecture on the autonomic nervous system was planned for the 1st year medical students in their biomedical science block of the first semester by the lecturers from anatomy and physiology and interactive lecture for 1 h and 30 min was delivered. After the session, responses were taken on a structured questionnaire with 10 questions on the Likert scale and a test was conducted to check their understandability. SPSS version 19.1 was used to analyze the results and data were reported based on descriptive statistics and scores were compared by t-test. Results: About 84.2% of the students wanted more lectures of this kind whereas 15.8% disagreed. About 80% stated that proper integration increased their understandability, whereas 83% preferred this modality in comparison to didactic lectures. Conclusions: This pedagogical approach with careful planning can be extended to involve clinical departments thus reaching vertical integration. Including more such integrated interactive sessions will prove to be significant and an effective tool for teaching and learning.

Integrated approaches to perceptual learning.

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Jacobs, Robert A

2010-04-01

New technologies and new ways of thinking have recently led to rapid expansions in the study of perceptual learning. We describe three themes shared by many of the nine articles included in this topic on Integrated Approaches to Perceptual Learning. First, perceptual learning cannot be studied on its own because it is closely linked to other aspects of cognition, such as attention, working memory, decision making, and conceptual knowledge. Second, perceptual learning is sensitive to both the stimulus properties of the environment in which an observer exists and to the properties of the tasks that the observer needs to perform. Moreover, the environmental and task properties can be characterized through their statistical regularities. Finally, the study of perceptual learning has important implications for society, including implications for science education and medical rehabilitation. Contributed articles relevant to each theme are summarized. Copyright © 2010 Cognitive Science Society, Inc.

Undergraduate medical student's perception about an integrated method of teaching at a medical school in Oman

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Harshal Sabane

2015-01-01

Full Text Available Objective In recent years, there has been a gradual but definitive shift in medical schools all over the globe to promote a more integrated way of teaching. Integration of medical disciplines promotes a holistic understanding of the medical curriculum in the students. This helps them better understand and appreciate the importance and role of each medical subject. Method The study was conducted among the 5th year Pre-clinical students. Questionnaire consisted of 4 questions on the level of integration, 5 questions on various aspects of the assessment and some questions which tested the level of awareness of the integrated method. Result Out of a total of 72 students present on the day of data collection, 65 participated in the study giving a response rate of 90.27 %. After primary data cleansing 4 questionnaires had to be omitted. Most of the students opined as “good” or “very good” for the questions on integration and its attributes. Only 27 (44 % were aware of integrated curriculum being taught in other medical schools in the gulf. Similar findings were observed regarding assessment related questions. Reduction in the number of block exams is unpopular among the students and only 6% have agreed for 3, 4, or 5 non-summative block assessments. Opinion regarding the help of integrated teaching in IFOM based OMSB entrance examination was mixed with a greater variance in the responses. 43% students have indicated that they would like to spend more time with PDCI. Conclusion The students of our institution seem to have a favourable opinion regarding the integrated system of teaching. The satisfaction with the conduct of examinations and its related variables is found to be high. A reduction in the number of block exams however is unpopular among the target group and they would appreciate a greater time allocation for subjects of PDCI and Pharmacology.

An integrated approach to risk assessment and mitigating the CBRN threat

International Nuclear Information System (INIS)

Bokan, S.

2009-01-01

CBRN mass casualty events threat mitigation remains today the highest international priority. Although significant progress has been made, the national security requirements for efforts to combat Weapons of Mass Destruction and Weapons of Mass Disruption will be of the highest national priority in the near future. An integration of a number of approaches is essential in the risk assessment and mitigating the CBRN treat. Preparedness measures and procedures, engineering, science and technology, policy, medical, and emergency response are essential to reduce the threat from the proliferation and use of weapons of mass destruction (WMD). Improved coordination between international, public and private security entities is also essential task to hopefully prevent the terrorist attacks. In this lecture, it will be presented very important scientific approach to risk assessment of potential use of nuclear, radiological, biological or chemical weapons in terrorist actions. An integrated approach for mitigating the CBRN threat, crisis management and preparedness measures for prevention and reduction of potential consequences, will be presented.(author)

Time for creative integration in medical sociology.

Science.gov (United States)

Levine, S

1995-01-01

The burgeoning of medical sociology has sometimes been accompanied by unfortunate parochialism and the presence of opposing intellectual camps that ignore and even impugn each other's work. We have lost opportunities to achieve creative discourse and integration of different perspectives, methods, and findings. At this stage we should consider how we can foster creative integration within our field.

Advancing medication infusion safety through the clinical integration of technology.

Science.gov (United States)

Gerhart, Donald; O'Shea, Kristen; Muller, Sharon

2013-01-01

Adverse drug events resulting from errors in prescribing or administering medications are preventable. Within a hospital system, numerous technologies are employed to address the common sources of medication error, including the use of electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. Infusion safety is inherently risky because of the high-risk medications administered and the lack of integration among the stand-alone systems in most institutions. Intravenous clinical integration (IVCI) is a technology that connects electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. It combines the safety features of an automatically programmed infusion pump (drug, concentration, infusion rate, and patient weight, all auto-programmed into the device) with software that provides visibility to real-time clinical infusion data. Our article describes the characteristics of IVCI at WellSpan Health and its impact on patient safety. The integrated infusion system has the capability of reducing medication errors, improving patient care, reducing in-facility costs, and supporting asset management. It can enhance continuous quality improvement efforts and efficiency of clinical work flow. After implementing IVCI, the institution realized a safer patient environment and a more streamlined work flow for pharmacy and nursing.

Medical information, communication, and archiving system (MICAS): Phase II integration and acceptance testing

Science.gov (United States)

Smith, Edward M.; Wandtke, John; Robinson, Arvin E.

1999-07-01

The Medical Information, Communication and Archive System (MICAS) is a multi-modality integrated image management system that is seamlessly integrated with the Radiology Information System (RIS). This project was initiated in the summer of 1995 with the first phase being installed during the first half of 1997 and the second phase installed during the summer of 1998. Phase II enhancements include a permanent archive, automated workflow including modality worklist, study caches, NT diagnostic workstations with all components adhering to Digital Imaging and Communications in Medicine (DICOM) standards. This multi-vendor phased approach to PACS implementation is designed as an enterprise-wide PACS to provide images and reports throughout our healthcare network. MICAS demonstrates that aa multi-vendor open system phased approach to PACS is feasible, cost-effective, and has significant advantages over a single vendor implementation.

Integrating Medical Simulation Into the Physician Assistant Physiology Curriculum.

Science.gov (United States)

Li, Lixin; Lopes, John; Zhou, Joseph Yi; Xu, Biao

2016-12-01

Medical simulation has recently been used in medical education, and evidence indicates that it is a valuable tool for teaching and evaluation. Very few studies have evaluated the integration of medical simulation in medical physiology education, particularly in PA programs. This study was designed to assess the value of integrating medical simulation into the PA physiology curriculum. Seventy-five students from the PA program at Central Michigan University participated in this study. Mannequin-based simulation was used to simulate a patient with hemorrhagic shock and congestive heart failure to demonstrate the Frank-Starling force and cardiac function curve. Before and after the medical simulation, students completed a questionnaire as a self-assessment. A knowledge test was also delivered after the simulation. Our study demonstrated a significant improvement in student confidence in understanding congestive heart failure, hemorrhagic shock, and the Frank-Starling curve after the simulation. Medical simulation may be an effective way to enhance basic science learning experiences for students and an ideal supplement to traditional, lecture-based teaching in PA education.

Teaching pharmacology to medical students in an integrated problem-based learning curriculum:an Australian perspective

Institute of Scientific and Technical Information of China (English)

Owen L WOODMAN; Agnes E DODDS; Albert G FRAUMAN; Mosepele MOSEPELE

2004-01-01

The world-wide move away from the didactic teaching of single disciples to integrated Problem-based Learning (PBL) curricula in medical education has posed challenges for the basic sciences. In this paper we identify two major challenges. The first challenge is the need to describe a core disciplinary curriculum that can be articulated and mapped onto the new structure. We illustrate how the British Pharmacological Society (BPS) Guidelines are used to evaluate the curriculum coverage in the medical course at The University of Melbourne. The second challenge is to ensure that foundational concepts are given adequate emphasis within the new structure, and in particular, that students have the opportunity to pursue these concepts in their self-directed learning. We illustrate one approach to teaching important pharmacological concepts in an integrated curriculum with a case study from the first year curriculum at The University of Melbourne. Finally, we propose the features of an integrated curriculum that facilitates the learning of basic pharmacology in a situation where PBL and integration sets the curriculum framework.

Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope.

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Heptonstall, N B; Ali, T; Mankad, K

2016-04-01

This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Towards a collaborative filtering approach to medication reconciliation.

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Hasan, Sharique; Duncan, George T; Neill, Daniel B; Padman, Rema

2008-11-06

A physicians prescribing decisions depend on knowledge of the patients medication list. This knowledge is often incomplete, and errors or omissions could result in adverse outcomes. To address this problem, the Joint Commission recommends medication reconciliation for creating a more accurate list of a patients medications. In this paper, we develop techniques for automatic detection of omissions in medication lists, identifying drugs that the patient may be taking but are not on the patients medication list. Our key insight is that this problem is analogous to the collaborative filtering framework increasingly used by online retailers to recommend relevant products to customers. The collaborative filtering approach enables a variety of solution techniques, including nearest neighbor and co-occurrence approaches. We evaluate the effectiveness of these approaches using medication data from a long-term care center in the Eastern US. Preliminary results suggest that this framework may become a valuable tool for medication reconciliation.

Horizontal and vertical integration of academic disciplines in the medical school curriculum.

Science.gov (United States)

Vidic, Branislav; Weitlauf, Harry M

2002-05-01

A rapid expansion of new scientific information and the introduction of new technology in operative and diagnostic medicine has marked the last several decades. Medical educators, because of and parallel to these developments, initiated a search for a more effective system of presenting core material to medical students. The new educational trends, although varying somewhat from one institution to another, concentrated on the following pedagogical shifts: 1) expansion of conceptual presentation of material at the expense of detail-oriented education; 2) amplification of an integrated approach, as opposed to subject-oriented instruction; 3) scheduling of elective courses to compliment required courses in the curriculum; and 4) institution of small group instruction (i.e., problem-based learning) to actively involve students in the educational process and to develop deductive reasoning based on clinical cases. The future pedagogical system in medical schools will most likely be a combination of "classical" presentation of material combined with concept-oriented, subject-integrated and small group instruction based on either hypothetical or real clinical cases. It is imperative for the success of the new curriculum, however, that certain criteria are satisfied: 1) reorganize basic science departments to determine course ownership; 2) establish a reward system for teaching faculty; and 3) establish new course objectives. Copyright 2002 Wiley-Liss, Inc.

From integrated control to integrated farming, an experimental approach

NARCIS (Netherlands)

Vereijken, P.H.

1989-01-01

Integrated control or integrated pest management (IPM), as envisaged originally, is not being practised to any large extent in arable farming, notwithstanding considerable research efforts. The reasons for this are discussed. A more basic approach called integrated farming is suggested. Preliminary

Key steps for integrating a basic science throughout a medical school curriculum using an e-learning approach.

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Dubois, Eline Agnès; Franson, Kari Lanette

2009-09-01

Basic sciences can be integrated into the medical school curriculum via e-learning. The process of integrating a basic science in this manner resembles a curricular change. The change usually begins with an idea for using e-learning to teach a basic science and establishing the need for the innovation. In the planning phase, learning outcomes are formulated and a prototype of the program is developed based on the desired requirements. A realistic concept is formed after considering the limitations of the current institute. Next, a project team is assembled to develop the program and plan its integration. Incorporation of the e-learning program is facilitated by a well-developed and communicated integration plan. Various course coordinators are contacted to determine content of the e-learning program as well as establish assessment. Linking the e-learning program to existing course activities and thereby applying the basic science into the clinical context enhances the degree of integration. The success of the integration is demonstrated by a positive assessment of the program including favourable cost-benefit analysis and improved student performance. Lastly, when the program becomes institutionalised, continuously updating content and technology (when appropriate), and evaluating the integration contribute to the prolonged survival of the e-learning program.

Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

Mohamed Amgad

Full Text Available Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during

Novel horizontal and vertical integrated bioethics curriculum for medical courses.

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D'Souza, Russell F; Mathew, Mary; D'Souza, Derek S J; Palatty, Princy

2018-02-28

Studies conducted by the University of Haifa, Israel in 2001, evaluating the effectiveness of bioethics being taught in medical colleges, suggested that there was a significant lack of translation in clinical care. Analysis also revealed, ineffectiveness with the teaching methodology used, lack of longitudinal integration of bioethics into the undergraduate medical curriculum, and the limited exposure to the technology in decision making when confronting ethical dilemmas. A modern novel bioethics curriculum and innovative methodology for teaching bioethics for the medical course was developed by the UNESCO Chair in Bioethics, Haifa. The horizontal (subject-wise) curriculum was vertically integrated seamlessly through the entire course. An innovative bioethics teaching methodology was employed to implement the curriculum. This new curriculum was piloted in a few medical colleges in India from 2011 to 2015 and the outcomes were evaluated. The evaluation confirmed gains over the earlier identified translation gap with added high student acceptability and satisfaction. This integrated curriculum is now formally implemented in the Indian program's Health Science Universities which is affiliated with over 200 medical schools in India. This article offers insights from the evaluated novel integrated bioethics curriculum and the innovative bioethics teaching methodology that was used in the pilot program.

The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

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Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G., Jr.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals

OpenAIRE

Heusser, Peter; Eberhard, Sabine; Berger, Bettina; Weinzirl, Johannes; Orlow, Pascale

2014-01-01

Background Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland...

Trends in hospital-physician integration in medical oncology.

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Clough, Jeffrey D; Dinan, Michaela A; Schulman, Kevin A

2017-10-01

Hospitals have rapidly acquired medical oncology practices in recent years. Experts disagree as to whether these trends are related to oncology-specific market factors or reflect a general trend of hospital-physician integration. The objective of this study was to compare the prevalence, geographic variation, and trends in physicians billing from hospital outpatient departments in medical oncology with other specialties. Retrospective analysis of Medicare claims data for 2012 and 2013. We calculated the proportion of physicians and practitioners in the 15 highest-volume specialties who billed the majority of evaluation and management visits from hospital outpatient departments in each year, nationally and by state. We included 338,998 and 352,321 providers in 2012 and 2013, respectively, of whom 9715 and 9969 were medical oncologists. Among the 15 specialties examined, medical oncology had the highest proportion of hospital outpatient department billing in 2012 and 2013 (35.0% and 38.3%, respectively). Medical oncology also experienced the greatest absolute change (3.3%) between the years, followed by thoracic surgery (2.4%) and cardiology (2.0%). There was marked state-level variation, with the proportion of medical oncologists based in hospital outpatient departments ranging from 0% in Nevada to 100% in Idaho. Hospital-physician integration has been more pronounced in medical oncology than in other high-volume specialties and is increasing at a faster rate. Policy makers should take these findings into consideration, particularly with respect to recent proposals that may continue to fuel these trends.

A web-based knowledge management system integrating Western and Traditional Chinese Medicine for relational medical diagnosis.

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Herrera-Hernandez, Maria C; Lai-Yuen, Susana K; Piegl, Les A; Zhang, Xiao

2016-10-26

This article presents the design of a web-based knowledge management system as a training and research tool for the exploration of key relationships between Western and Traditional Chinese Medicine, in order to facilitate relational medical diagnosis integrating these mainstream healing modalities. The main goal of this system is to facilitate decision-making processes, while developing skills and creating new medical knowledge. Traditional Chinese Medicine can be considered as an ancient relational knowledge-based approach, focusing on balancing interrelated human functions to reach a healthy state. Western Medicine focuses on specialties and body systems and has achieved advanced methods to evaluate the impact of a health disorder on the body functions. Identifying key relationships between Traditional Chinese and Western Medicine opens new approaches for health care practices and can increase the understanding of human medical conditions. Our knowledge management system was designed from initial datasets of symptoms, known diagnosis and treatments, collected from both medicines. The datasets were subjected to process-oriented analysis, hierarchical knowledge representation and relational database interconnection. Web technology was implemented to develop a user-friendly interface, for easy navigation, training and research. Our system was prototyped with a case study on chronic prostatitis. This trial presented the system's capability for users to learn the correlation approach, connecting knowledge in Western and Traditional Chinese Medicine by querying the database, mapping validated medical information, accessing complementary information from official sites, and creating new knowledge as part of the learning process. By addressing the challenging tasks of data acquisition and modeling, organization, storage and transfer, the proposed web-based knowledge management system is presented as a tool for users in medical training and research to explore, learn and

Elderly patient refractory to multiple pain medications successfully treated with integrative East–West medicine

Directory of Open Access Journals (Sweden)

Bill Tu

2008-07-01

Full Text Available Bill Tu, Michael Johnston, Ka-Kit HuiUCLA Center for East–West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USABackground: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence.Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL.Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.Keywords: polypharmacy, pain, osteoarthritis, acupuncture, complementary and alternative medicine, integrative medicine, adverse drug reaction, elderly

Rethinking medical humanities.

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Chiapperino, Luca; Boniolo, Giovanni

2014-12-01

This paper questions different conceptions of Medical Humanities in order to provide a clearer understanding of what they are and why they matter. Building upon former attempts, we defend a conception of Medical Humanities as a humanistic problem-based approach to medicine aiming at influencing its nature and practice. In particular, we discuss three main conceptual issues regarding the overall nature of this discipline: (i) a problem-driven approach to Medical Humanities; (ii) the need for an integration of Medical Humanities into medicine; (iii) the methodological requirements that could render Medical Humanities an effective framework for medical decision-making.

Integrating psychology and obstetrics for medical students: shared labour ward teaching.

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Chalmers, B E; McIntyre, J A

1993-01-01

Two studies relating to the inclusion of psycho-social issues in the training of obstetricians are reported here. The first reports on the extent to which currently practising obstetricians have received training in these aspects. The second explored the value of an innovative teaching approach combining psychological and obstetric training for medical students in the labour ward. A postal survey with responses from 220 obstetricians and paediatricians revealed that little information on psychological aspects of obstetric practice had been included in their undergraduate or postgraduate training or obtained from voluntary continuing education programmes. Experience was the primary source of training in these subjects. The second study explored the impact of joint psychological and obstetric teaching ward rounds for medical students. Students attending these integrated sessions reported being better prepared for the psycho-social aspects of obstetrics and showed a greater awareness of cross-cultural differences in needs of women during birth.

Clinical capabilities of graduates of an outcomes-based integrated medical program

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Scicluna Helen A

2012-06-01

Full Text Available Abstract Background The University of New South Wales (UNSW Faculty of Medicine replaced its old content-based curriculum with an innovative new 6-year undergraduate entry outcomes-based integrated program in 2004. This paper is an initial evaluation of the perceived and assessed clinical capabilities of recent graduates of the new outcomes-based integrated medical program compared to benchmarks from traditional content-based or process-based programs. Method Self-perceived capability in a range of clinical tasks and assessment of medical education as preparation for hospital practice were evaluated in recent graduates after 3 months working as junior doctors. Responses of the 2009 graduates of the UNSW’s new outcomes-based integrated medical education program were compared to those of the 2007 graduates of UNSW’s previous content-based program, to published data from other Australian medical schools, and to hospital-based supervisor evaluations of their clinical competence. Results Three months into internship, graduates from UNSW’s new outcomes-based integrated program rated themselves to have good clinical and procedural skills, with ratings that indicated significantly greater capability than graduates of the previous UNSW content-based program. New program graduates rated themselves significantly more prepared for hospital practice in the confidence (reflective practice, prevention (social aspects of health, interpersonal skills (communication, and collaboration (teamwork subscales than old program students, and significantly better or equivalent to published benchmarks of graduates from other Australian medical schools. Clinical supervisors rated new program graduates highly capable for teamwork, reflective practice and communication. Conclusions Medical students from an outcomes-based integrated program graduate with excellent self-rated and supervisor-evaluated capabilities in a range of clinically-relevant outcomes. The program

Integrating clinical communication with clinical reasoning and the broader medical curriculum.

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Cary, Julie; Kurtz, Suzanne

2013-09-01

The objectives of this paper are to discuss the results of a workshop conducted at EACH 2012. Specifically, we will (1) examine the link between communication, clinical reasoning, and medical problem solving, (2) explore strategies for (a) integrating clinical reasoning, medical problem solving, and content from the broader curriculum into clinical communication teaching and (b) integrating communication into the broader curriculum, and (3) discuss benefits gained from such integration. Salient features from the workshop were recorded and will be presented here, as well as a case example to illustrate important connections between clinical communication and clinical reasoning. Potential links between clinical communication, clinical reasoning, and medical problem solving as well as strategies to integrate clinical communication teaching and the broader curricula in human and veterinary medicine are enumerated. Participants expressed enthusiasm and keen interest in integration of clinical communication teaching and clinical reasoning during this workshop, came to the idea of the interdependence of these skills easily, and embraced the rationale immediately. Valuing the importance of communication as clinical skill and embracing the interdependence between communication and thought processes related to clinical reasoning and medical problem solving will be beneficial in teaching programs. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Sleep Disruption Medical Intervention Forecasting (SDMIF) Module for the Integrated Medical Model

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Lewandowski, Beth; Brooker, John; Mallis, Melissa; Hursh, Steve; Caldwell, Lynn; Myers, Jerry

2011-01-01

The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fatigue due to sleep disruption is a condition that could lead to operational errors, potentially resulting in loss of mission or crew. Pharmacological consumables are mitigation strategies used to manage the risks associated with sleep deficits. The likelihood of medical intervention due to sleep disruption was estimated with a well validated sleep model and a Monte Carlo computer simulation in an effort to optimize the quantity of consumables. METHODS: The key components of the model are the mission parameter program, the calculation of sleep intensity and the diagnosis and decision module. The mission parameter program was used to create simulated daily sleep/wake schedules for an ISS increment. The hypothetical schedules included critical events such as dockings and extravehicular activities and included actual sleep time and sleep quality. The schedules were used as inputs to the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model (IBR Inc., Baltimore MD), which calculated sleep intensity. Sleep data from an ISS study was used to relate calculated sleep intensity to the probability of sleep medication use, using a generalized linear model for binomial regression. A human yes/no decision process using a binomial random number was also factored into sleep medication use probability. RESULTS: These probability calculations were repeated 5000 times resulting in an estimate of the most likely amount of sleep aids used during an ISS mission and a 95% confidence interval. CONCLUSIONS: These results were transferred to the parent IMM for further weighting and integration with other medical conditions, to help inform operational decisions. This model is a potential planning tool for ensuring adequate sleep during sleep disrupted periods of a mission.

A semantic medical multimedia retrieval approach using ontology information hiding.

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Guo, Kehua; Zhang, Shigeng

2013-01-01

Searching useful information from unstructured medical multimedia data has been a difficult problem in information retrieval. This paper reports an effective semantic medical multimedia retrieval approach which can reflect the users' query intent. Firstly, semantic annotations will be given to the multimedia documents in the medical multimedia database. Secondly, the ontology that represented semantic information will be hidden in the head of the multimedia documents. The main innovations of this approach are cross-type retrieval support and semantic information preservation. Experimental results indicate a good precision and efficiency of our approach for medical multimedia retrieval in comparison with some traditional approaches.

The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

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Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G.

2015-01-01

The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

Integration of leadership training into a problem/case-based learning program for first- and second-year medical students.

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Ginzburg, Samara B; Deutsch, Susan; Bellissimo, Jaclyn; Elkowitz, David E; Stern, Joel Nh; Lucito, Robert

2018-01-01

The evolution of health care systems in response to societal and financial pressures has changed care delivery models, which presents new challenges for physicians. Leadership training is increasingly being recognized as an essential component of medical education training to prepare physicians to meet these needs. Unfortunately, most medical schools do not include leadership training. It has been suggested that a longitudinal and integrated approach to leadership training should be sought. We hypothesized that integration of leadership training into our hybrid problem-based learning (PBL)/case-based learning (CBL) program, Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), would be an effective way for medical students to develop leadership skills without the addition of curricular time. We designed a unique leadership program in PEARLS in which 98 medical students participated during each of their six courses throughout the first 2 years of school. A program director and trained faculty facilitators educated students and coached them on leadership development throughout this time. Students were assessed by their facilitator at the end of every course on development of leadership skills related to teamwork, meaningful self-assessment, process improvement, and thinking outside the box. Students consistently improved their performance from the first to the final course in all four leadership parameters evaluated. The skills that demonstrated the greatest change were those pertaining to thinking outside the box and process improvement. Incorporation of a longitudinal and integrated approach to leadership training into an existing PBL/CBL program is an effective way for medical students to improve their leadership skills without the addition of curricular time. These results offer a new, time-efficient option for leadership development in schools with existing PBL/CBL programs.

Novel Dissection of the Central Nervous System to Bridge Gross Anatomy and Neuroscience for an Integrated Medical Curriculum

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Hlavac, Rebecca J.; Klaus, Rachel; Betts, Kourtney; Smith, Shilo M.; Stabio, Maureen E.

2018-01-01

Medical schools in the United States continue to undergo curricular change, reorganization, and reformation as more schools transition to an integrated curriculum. Anatomy educators must find novel approaches to teach in a way that will bridge multiple disciplines. The cadaveric extraction of the central nervous system (CNS) provides an…

The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

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Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

2009-01-01

The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

Oncology Education in Medical Schools: Towards an Approach that Reflects Australia's Health Care Needs.

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McRae, Robert J

2016-12-01

Cancer has recently overtaken heart disease to become the number 1 cause of mortality both globally and in Australia. As such, adequate oncology education must be an integral component of medical school if students are to achieve learning outcomes that meet the needs of the population. The aim of this review is to evaluate the current state of undergraduate oncology education and identify how Australian medical schools can improve oncology learning outcomes for students and, by derivative, improve healthcare outcomes for Australians with cancer. The review shows that oncology is generally not well represented in medical school curricula, that few medical schools offer mandatory oncology or palliative care rotations, and that junior doctors are exhibiting declining oncology knowledge and skills. To address these issues, Australian medical schools should implement the Oncology Education Committee's Ideal Oncology Curriculum, enact mandatory oncology and palliative care clinical rotations for students, and in doing so, appreciate the importance of students' differing approaches to learning.

A novel system architecture for the national integration of electronic health records: a semi-centralized approach.

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AlJarullah, Asma; El-Masri, Samir

2013-08-01

The goal of a national electronic health records integration system is to aggregate electronic health records concerning a particular patient at different healthcare providers' systems to provide a complete medical history of the patient. It holds the promise to address the two most crucial challenges to the healthcare systems: improving healthcare quality and controlling costs. Typical approaches for the national integration of electronic health records are a centralized architecture and a distributed architecture. This paper proposes a new approach for the national integration of electronic health records, the semi-centralized approach, an intermediate solution between the centralized architecture and the distributed architecture that has the benefits of both approaches. The semi-centralized approach is provided with a clearly defined architecture. The main data elements needed by the system are defined and the main system modules that are necessary to achieve an effective and efficient functionality of the system are designed. Best practices and essential requirements are central to the evolution of the proposed architecture. The proposed architecture will provide the basis for designing the simplest and the most effective systems to integrate electronic health records on a nation-wide basis that maintain integrity and consistency across locations, time and systems, and that meet the challenges of interoperability, security, privacy, maintainability, mobility, availability, scalability, and load balancing.

Development of a longitudinal integrated clerkship at an academic medical center.

Science.gov (United States)

Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia

2011-04-04

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

An integrated approach to telemonitoring noncommunicable diseases: best practice from the European innovation partnership on active and healthy ageing.

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Bourret, Rodolphe; Bousquet, Jean

2013-01-01

The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has prioritized noncommunicable diseases (NCDs). An innovative integrated health system built around medical systems and strategic partnerships is proposed to combat NCDs. Information and communication technology (ICT) is needed for the implementation of integrated care in a medical systems approach. The Teaching Hospital of Montpellier has set up the clinic and uses IP-Soins as an ICT tool. Patients with NCDs will be referred to the chronic disease clinic of the hospital by a primary care physician. This paper reviews the complexity of NCDs intertwined with ageing. It gives an overview of the problem. It presents an innovative approach in the implementation of a clinical information system in a "SaaS" (Software as a Service) mode.

Integrating medical and environmental sociology with environmental health: crossing boundaries and building connections through advocacy.

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Brown, Phil

2013-06-01

This article reviews the personal and professional processes of developing an interdisciplinary approach to understanding the complex issues of environmental health in their community, political-economic, social science, and scientific contexts. This interdisciplinary approach includes a synthesis of research, policy work, and advocacy. To examine multiple forms of interdisciplinarity, I examine pathways of integrating medical and environmental sociology via three challenges to the boundaries of traditional research: (1) crossing the boundaries of medical and environmental sociology, (2) linking social science and environmental health science, and (3) crossing the boundary of research and advocacy. These boundary crossings are discussed in light of conceptual and theoretical developments of popular epidemiology, contested illnesses, and health social movements. This interdisciplinary work offers a more comprehensive sociological lens for understanding complex problems and a practical ability to join with scientists, activists, and officials to meet public health needs for amelioration and prevention of environmental health threats.

Clear Channel Assessment in Integrated Medical Environments

Directory of Open Access Journals (Sweden)

Hara Shinsuke

2008-01-01

Full Text Available Abstract Complementary WLAN and WPAN technologies as well as other wireless technologies will play a fundamental role in the medical environments to support ubiquitous healthcare delivery. This paper investigates clear channel assessment (CCA and its impact on the coexistence of WLAN (IEEE 802.11 high rate direct sequence spread spectrum (HR/DSSS PHY and WPAN (IEEE 802.15.4b in the 2.4 GHz industrial, scientific, and medical (ISM band. We derived closed-form expressions of both energy-based CCA and feature-based CCA. We qualified unequal sensing abilities between them and termed this inequality asymmetric CCA, which is different from the traditional "hidden node" or "exposed node" issues in the homogeneous network. The energy-based CCA was considered in the considered integrated medical environment because the 2.4 GHz ISM band is too crowded to apply feature-based CCA. The WPAN is oversensitive to the 802.11 HR/DSSS signals and the WLAN is insensitive to the 802.15.4b signals. Choosing an optimal CCA threshold requires some prior knowledge of the underlying signals. In the integrated medical environment we considered here, energy-based CCA can effectively avoid possible packet collisions when they are close within the "heterogeneous exclusive CCA range" (HECR. However, when they are separated beyond the HECR, WPAN can still sense the 802.11 HR/DSSS signals, but WLAN loses its sense to the 802.15.4b signals. The asymmetric CCA leads to WPAN traffic in a position secondary to WLAN traffic.

National standards in pathology education: developing competencies for integrated medical school curricula.

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Sadofsky, Moshe; Knollmann-Ritschel, Barbara; Conran, Richard M; Prystowsky, Michael B

2014-03-01

Medical school education has evolved from department-specific memorization of facts to an integrated curriculum presenting knowledge in a contextual manner across traditional disciplines, integrating information, improving retention, and facilitating application to clinical practice. Integration occurs throughout medical school using live data-sharing technologies, thereby providing the student with a framework for lifelong active learning. Incorporation of educational teams during medical school prepares students for team-based patient care, which is also required for pay-for-performance models used in accountable care organizations. To develop learning objectives for teaching pathology to medical students. Given the rapid expansion of basic science knowledge of human development, normal function, and pathobiology, it is neither possible nor desirable for faculty to teach, and students to retain, this vast amount of information. Courses teaching the essentials in context and engaging students in the learning process enable them to become lifelong learners. An appreciation of pathobiology and the role of laboratory medicine underlies the modern practice of medicine. As such, all medical students need to acquire 3 basic competencies in pathology: an understanding of disease mechanisms, integration of mechanisms into organ system pathology, and application of pathobiology to diagnostic medicine. We propose the development of 3 specific competencies in pathology to be implemented nationwide, aimed at disease mechanisms/processes, organ system pathology, and application to diagnostic medicine. Each competency will include learning objectives and a means to assess acquisition, integration, and application of knowledge. The learning objectives are designed to be a living document managed (curated) by a group of pathologists representing Liaison Committee on Medical Education-accredited medical schools nationally. Development of a coherent set of learning objectives will

An Integrated Computer-Aided Approach for Environmental Studies

DEFF Research Database (Denmark)

Gani, Rafiqul; Chen, Fei; Jaksland, Cecilia

1997-01-01

A general framework for an integrated computer-aided approach to solve process design, control, and environmental problems simultaneously is presented. Physicochemical properties and their relationships to the molecular structure play an important role in the proposed integrated approach. The sco...... and applicability of the integrated approach is highlighted through examples involving estimation of properties and environmental pollution prevention. The importance of mixture effects on some environmentally important properties is also demonstrated....

A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care.

Science.gov (United States)

Vannoy, Steven D; Mauer, Barbara; Kern, John; Girn, Kamaljeet; Ingoglia, Charles; Campbell, Jeannie; Galbreath, Laura; Unützer, Jürgen

2011-07-01

Integration of general medical and mental health services is a growing priority for safety-net providers. The authors describe a project that established a one-year learning collaborative focused on integration of services between community health centers (CHCs) and community mental health centers (CMHCs). Specific targets were treatment for general medical and psychiatric symptoms related to depression, bipolar disorder, alcohol use disorders, and metabolic syndrome. This observational study used mixed methods. Quantitative measures included 15 patient-level health indicators, practice self-assessment of resources and support for chronic disease self-management, and participant satisfaction. Sixteen CHC-CMHC pairs were selected for the learning collaborative series. One pair dropped out because of personnel turnover. All teams increased capacity on one or more patient health indicators. CHCs scored higher than CMHCs on support for chronic disease self-management. Participation in the learning collaborative increased self-assessment scores for CHCs and CMHCs. Participant satisfaction was high. Observations by faculty indicate that quality improvement challenges included tracking patient-level outcomes, workforce issues, and cross-agency communication. Even though numerous systemic barriers were encountered, the findings support existing literature indicating that the learning collaborative is a viable quality improvement approach for enhancing integration of general medical and mental health services between CHCs and CMHCs. Real-world implementation of evidence-based guidelines presents challenges often absent in research. Technical resources and support, a stable workforce with adequate training, and adequate opportunities for collaborator communications are particular challenges for integrating behavioral and general medical services across CHCs and CMHCs.

An approach to human-centered design of nuclear medical equipment: the system of caption of the thyroid

International Nuclear Information System (INIS)

Santos, Isaac J.A. Luquetti; Silva, Carlos Borges da; Santana, Marcos; Carvalho, Paulo Victor R.; Oliveira, Mauro Vitor de; Mol, Antonio Carlos Mol; Grecco, Claudio Henrique; Augusto, Silas Cordeiro

2005-01-01

Technology plays an important role in modern medical centers, making health care increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine and can increase the risks for human error. Human error has many causes such as performance shaping factors, organizational factors and user interface design. Poorly design human system interfaces of nuclear medical equipment can increase the risks for human error. If all nuclear medical equipment had been designed with good user interfaces, incidents and accidents could be reduced as well as he time required to learn how to use the equipment. Although some manufacturers of nuclear medical equipment have already integrate human factors principles in their products, there is still a need to steer the development of nuclear medical technology toward more human-centered approach. The aim of this paper is to propose a methodology that contributes to the design, development and evaluation of nuclear medical equipment and human system interface, towards a human-centered approach. This methodology includes the ergonomic approach, based on the operator activity analysis, together with human factors standards and guidelines, questionnaires and user based testing. We describe a case study in which this methodology is being applied in evaluation of the thyroid uptake system, getting essential information and data, that ill be used in development of a new system. (author)

Integrating social factors into cross-cultural medical education.

Science.gov (United States)

Green, Alexander R; Betancourt, Joseph R; Carrillo, J Emilio

2002-03-01

The field of cross-cultural medical education has blossomed in an environment of increasing diversity and increasing awareness of the effect of race and ethnicity on health outcomes. However, there is still no standardized approach to teaching doctors in training how best to care for diverse patient populations. As standards are developed, it is crucial to realize that medical educators cannot teach about culture in a vacuum. Caring for patients of diverse cultural backgrounds is inextricably linked to caring for patients of diverse social backgrounds. In this article, the authors discuss the importance of social issues in caring for patients of all cultures, and propose a practical, patient-based approach to social analysis covering four major domains--(1) social stress and support networks, (2) change in environment, (3) life control, and (4) literacy. By emphasizing and expanding the role of the social history in cross-cultural medical education, faculty can better train medical students, residents, and other health care providers to care for socioculturally diverse patient populations.

Medical Device Integration Model Based on the Internet of Things

Science.gov (United States)

Hao, Aiyu; Wang, Ling

2015-01-01

At present, hospitals in our country have basically established the HIS system, which manages registration, treatment, and charge, among many others, of patients. During treatment, patients need to use medical devices repeatedly to acquire all sorts of inspection data. Currently, the output data of the medical devices are often manually input into information system, which is easy to get wrong or easy to cause mismatches between inspection reports and patients. For some small hospitals of which information construction is still relatively weak, the information generated by the devices is still presented in the form of paper reports. When doctors or patients want to have access to the data at a given time again, they can only look at the paper files. Data integration between medical devices has long been a difficult problem for the medical information system, because the data from medical devices are lack of mandatory unified global standards and have outstanding heterogeneity of devices. In order to protect their own interests, manufacturers use special protocols, etc., thus causing medical decices to still be the "lonely island" of hospital information system. Besides, unfocused application of the data will lead to failure to achieve a reasonable distribution of medical resources. With the deepening of IT construction in hospitals, medical information systems will be bound to develop towards mobile applications, intelligent analysis, and interconnection and interworking, on the premise that there is an effective medical device integration (MDI) technology. To this end, this paper presents a MDI model based on the Internet of Things (IoT). Through abstract classification, this model is able to extract the common characteristics of the devices, resolve the heterogeneous differences between them, and employ a unified protocol to integrate data between devices. And by the IoT technology, it realizes interconnection network of devices and conducts associate matching

Extending the theoretical framework for curriculum integration in pre-clinical medical education

DEFF Research Database (Denmark)

Vergel, John; Stentoft, Diana; Montoya, Juny

2017-01-01

students' knowledge integration. Therefore, we aimed to uncover how curriculum integration is manifested through context. METHODS: We collected data from the official curriculum and interviewed ten participants (including curriculum designers, facilitators, and students) in the bachelor's medical program......INTRODUCTION: Curriculum integration is widely discussed in medical education but remains ill defined. Although there is plenty of information on logistical aspects of curriculum integration, little attention has been paid to the contextual issues that emerge from its practice and may complicate...... at Aalborg University. We observed various learning activities focused on pre-clinical education. Inspired by grounded theory, we analyzed the information we gathered. RESULTS: The following theoretical constructs emerged after the inductive analysis: 1) curriculum integration complexity is embedded...

Holistic integrative medicine: toward a new era of medical advancement.

Science.gov (United States)

Fan, Daiming

2017-03-01

Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.

Medical back belt with integrated neuromuscular electrical stimulation

NARCIS (Netherlands)

Bottenberg, E. (Eliza); Brinks, G.J. (Ger); Hesse, J. (Jenny)

2014-01-01

The medical back belt with integrated neuromuscular electrical stimulation is anorthopedic device, which has two main functions. The first function is to stimulate the backmuscles by using a neuromuscular electrical stimulation device that releases regular,electrical impulses. The second function of

Development of a longitudinal integrated clerkship at an academic medical center

Directory of Open Access Journals (Sweden)

Ann Poncelet

2011-04-01

Full Text Available In 2005, medical educators at the University of California, San Francisco (UCSF, began developing the Parnassus Integrated Student Clinical Experiences (PISCES program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants’ career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

Implementation of a competency-based medical education approach in public health and epidemiology training of medical students

Directory of Open Access Journals (Sweden)

Rachel Dankner

2018-02-01

Full Text Available Abstract Background There is increasing agreement among medical educators regarding the importance of improving the integration between public health and clinical education, understanding and implementation of epidemiological methods, and the ability to critically appraise medical literature. The Sackler School of Medicine at Tel-Aviv University revised its public health and preventive medicine curriculum, during 2013–2014, according to the competency-based medical education (CBME approach in training medical students. We describe the revised curriculum, which aimed to strengthen competencies in quantitative research methods, epidemiology, public health and preventive medicine, and health service organization and delivery. Methods We report the process undertaken to establish a relevant 6-year longitudinal curriculum and describe its contents, implementation, and continuous assessment and evaluation. Results Central competencies included: epidemiology and statistics for appraisal of the literature and implementation of research; the application of health promotion principles and health education strategies in disease prevention; the use of an evidence-based approach in clinical and public health decision making; the examination and analysis of disease trends at the population level; and knowledge of the structure of health systems and the role of the physician in these systems. Two new courses, in health promotion, and in public health, were added to the curriculum, and the courses in statistics and epidemiology were joined. Annual evaluation of each course results in continuous revisions of the syllabi as needed, while we continue to monitor the whole curriculum. Conclusions The described revision in a 6 year-medical school training curriculum addresses the currently identified needs in public health. Ongoing feedback from students, and re-evaluation of syllabus by courses teams are held annually. Analysis of student’s written feedbacks

Integrating advanced practice providers into medical critical care teams.

Science.gov (United States)

McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

2013-03-01

Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

PSYCHE: An Object-Oriented Approach to Simulating Medical Education

Science.gov (United States)

Mullen, Jamie A.

1990-01-01

Traditional approaches to computer-assisted instruction (CAI) do not provide realistic simulations of medical education, in part because they do not utilize heterogeneous knowledge bases for their source of domain knowledge. PSYCHE, a CAI program designed to teach hypothetico-deductive psychiatric decision-making to medical students, uses an object-oriented implementation of an intelligent tutoring system (ITS) to model the student, domain expert, and tutor. It models the transactions between the participants in complex transaction chains, and uses heterogeneous knowledge bases to represent both domain and procedural knowledge in clinical medicine. This object-oriented approach is a flexible and dynamic approach to modeling, and represents a potentially valuable tool for the investigation of medical education and decision-making.

Integrated approach to economical, reliable, safe nuclear power production

International Nuclear Information System (INIS)

1982-06-01

An Integrated Approach to Economical, Reliable, Safe Nuclear Power Production is the latest evolution of a concept which originated with the Defense-in-Depth philosophy of the nuclear industry. As Defense-in-Depth provided a framework for viewing physical barriers and equipment redundancy, the Integrated Approach gives a framework for viewing nuclear power production in terms of functions and institutions. In the Integrated Approach, four plant Goals are defined (Normal Operation, Core and Plant Protection, Containment Integrity and Emergency Preparedness) with the attendant Functional and Institutional Classifications that support them. The Integrated Approach provides a systematic perspective that combines the economic objective of reliable power production with the safety objective of consistent, controlled plant operation

Healing and Preventing Pain: Complementary and Integrative Approaches

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... page please turn JavaScript on. Feature: Pain Management Healing and Preventing Pain, Complementary and Integrative Approaches Past ... Pain Management" Articles Putting A Pause In Pain / Healing and Preventing Pain Complementary and Integrative Approaches / Pain ...

Architecture of portable electronic medical records system integrated with streaming media.

Science.gov (United States)

Chen, Wei; Shih, Chien-Chou

2012-02-01

Due to increasing occurrence of accidents and illness during business trips, travel, or overseas studies, the requirement for portable EMR (Electronic Medical Records) has increased. This study proposes integrating streaming media technology into the EMR system to facilitate referrals, contracted laboratories, and disease notification among hospitals. The current study encoded static and dynamic medical images of patients into a streaming video format and stored them in a Flash Media Server (FMS). Based on the Taiwan Electronic Medical Record Template (TMT) standard, EMR records can be converted into XML documents and used to integrate description fields with embedded streaming videos. This investigation implemented a web-based portable EMR interchanging system using streaming media techniques to expedite exchanging medical image information among hospitals. The proposed architecture of the portable EMR retrieval system not only provides local hospital users the ability to acquire EMR text files from a previous hospital, but also helps access static and dynamic medical images as reference for clinical diagnosis and treatment. The proposed method protects property rights of medical images through information security mechanisms of the Medical Record Interchange Service Center and Health Certificate Authorization to facilitate proper, efficient, and continuous treatment of patients.

Integrating health economics modeling in the product development cycle of medical devices: a Bayesian approach.

Science.gov (United States)

Vallejo-Torres, Laura; Steuten, Lotte M G; Buxton, Martin J; Girling, Alan J; Lilford, Richard J; Young, Terry

2008-01-01

Medical device companies are under growing pressure to provide health-economic evaluations of their products. Cost-effectiveness analyses are commonly undertaken as a one-off exercise at the late stage of development of new technologies; however, the benefits of an iterative use of economic evaluation during the development process of new products have been acknowledged in the literature. Furthermore, the use of Bayesian methods within health technology assessment has been shown to be of particular value in the dynamic framework of technology appraisal when new information becomes available in the life cycle of technologies. In this study, we set out a methodology to adapt these methods for their application to directly support investment decisions in a commercial setting from early stages of the development of new medical devices. Starting with relatively simple analysis from the very early development phase and proceeding to greater depth of analysis at later stages, a Bayesian approach facilitates the incorporation of all available evidence and would help companies to make better informed choices at each decision point.

Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise's cross-enterprise document sharing integration profile.

Science.gov (United States)

Wu, Chien Hua; Chiu, Ruey Kei; Yeh, Hong Mo; Wang, Da Wei

2017-11-01

In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service. In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise's Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system. The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system. The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios. Copyright © 2017 Elsevier B.V. All rights reserved.

A Strategic Approach to Medical Care for Exploration Missions

Science.gov (United States)

Canga, Michael A.; Shah, Ronak V.; Mindock, Jennifer A.; Antonsen, Erik L.

2016-01-01

Exploration missions will present significant new challenges to crew health, including effects of variable gravity environments, limited communication with Earth-based personnel for diagnosis and consultation for medical events, limited resupply, and limited ability for crew return. Providing health care capabilities for exploration class missions will require system trades be performed to identify a minimum set of requirements and crosscutting capabilities, which can be used in design of exploration medical systems. Medical data, information, and knowledge collected during current space missions must be catalogued and put in formats that facilitate querying and analysis. These data are used to inform the medical research and development program through analysis of risk trade studies between medical care capabilities and system constraints such as mass, power, volume, and training. Medical capability as a quantifiable variable is proposed as a surrogate risk metric and explored for trade space analysis that can improve communication between the medical and engineering approaches to mission design. The resulting medical system design approach selected will inform NASA mission architecture, vehicle, and subsystem design for the next generation of spacecraft.

An integrated model for developing research skills in an undergraduate medical curriculum: appraisal of an approach using student selected components.

Science.gov (United States)

Riley, Simon C; Morton, Jeremy; Ray, David C; Swann, David G; Davidson, Donald J

2013-09-01

Student selected components (SSCs), at that time termed special study modules, were arguably the most innovative element in Tomorrow's Doctors (1993), the document from the General Medical Council that initiated the modernization of medical curricula in the UK. SSCs were proposed to make up one-third of the medical curriculum and provide students with choice, whilst allowing individual schools autonomy in how SSCs were utilized. In response, at the University of Edinburgh the undergraduate medical curriculum provides an integrated and sequential development and assessment of research skill learning outcomes, for all students in the SSC programme. The curriculum contains SSCs which provide choice to students in all 5 years. There are four substantial timetabled SSCs where students develop research skills in a topic and speciality of their choice. These SSCs are fully integrated and mapped with core learning outcomes and assessment, particularly with the 'Evidence-Based Medicine and Research' programme theme. These research skills are developed incrementally and applied fully in a research project in the fourth year. One-third of students also perform an optional intercalated one-year honours programme between years 2 and 3, usually across a wide range of honours schools at the biomedical science interface. Student feedback is insightful and demonstrates perceived attainment of research competencies. The establishment of these competencies is discussed in the context of enabling junior graduate doctors to be effective and confident at utilizing their research skills to effectively practice evidence-based medicine. This includes examining their own practice through clinical audit, developing an insight into the complexity of the evidence base and uncertainty, and also gaining a view into a career as a clinical academic.

Semantic Health Knowledge Graph: Semantic Integration of Heterogeneous Medical Knowledge and Services

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Longxiang Shi

2017-01-01

Full Text Available With the explosion of healthcare information, there has been a tremendous amount of heterogeneous textual medical knowledge (TMK, which plays an essential role in healthcare information systems. Existing works for integrating and utilizing the TMK mainly focus on straightforward connections establishment and pay less attention to make computers interpret and retrieve knowledge correctly and quickly. In this paper, we explore a novel model to organize and integrate the TMK into conceptual graphs. We then employ a framework to automatically retrieve knowledge in knowledge graphs with a high precision. In order to perform reasonable inference on knowledge graphs, we propose a contextual inference pruning algorithm to achieve efficient chain inference. Our algorithm achieves a better inference result with precision and recall of 92% and 96%, respectively, which can avoid most of the meaningless inferences. In addition, we implement two prototypes and provide services, and the results show our approach is practical and effective.

Clear Channel Assessment in Integrated Medical Environments

Directory of Open Access Journals (Sweden)

Bin Zhen

2008-03-01

Full Text Available Complementary WLAN and WPAN technologies as well as other wireless technologies will play a fundamental role in the medical environments to support ubiquitous healthcare delivery. This paper investigates clear channel assessment (CCA and its impact on the coexistence of WLAN (IEEE 802.11 high rate direct sequence spread spectrum (HR/DSSS PHY and WPAN (IEEE 802.15.4b in the 2.4 GHz industrial, scientific, and medical (ISM band. We derived closed-form expressions of both energy-based CCA and feature-based CCA. We qualified unequal sensing abilities between them and termed this inequality asymmetric CCA, which is different from the traditional “hidden node” or “exposed node” issues in the homogeneous network. The energy-based CCA was considered in the considered integrated medical environment because the 2.4 GHz ISM band is too crowded to apply feature-based CCA. The WPAN is oversensitive to the 802.11 HR/DSSS signals and the WLAN is insensitive to the 802.15.4b signals. Choosing an optimal CCA threshold requires some prior knowledge of the underlying signals. In the integrated medical environment we considered here, energy-based CCA can effectively avoid possible packet collisions when they are close within the “heterogeneous exclusive CCA range” (HECR. However, when they are separated beyond the HECR, WPAN can still sense the 802.11 HR/DSSS signals, but WLAN loses its sense to the 802.15.4b signals. The asymmetric CCA leads to WPAN traffic in a position secondary to WLAN traffic.

Integration a functional approach

CERN Document Server

Bichteler, Klaus

1998-01-01

This book covers Lebesgue integration and its generalizations from Daniell's point of view, modified by the use of seminorms. Integrating functions rather than measuring sets is posited as the main purpose of measure theory. From this point of view Lebesgue's integral can be had as a rather straightforward, even simplistic, extension of Riemann's integral; and its aims, definitions, and procedures can be motivated at an elementary level. The notion of measurability, for example, is suggested by Littlewood's observations rather than being conveyed authoritatively through definitions of (sigma)-algebras and good-cut-conditions, the latter of which are hard to justify and thus appear mysterious, even nettlesome, to the beginner. The approach taken provides the additional benefit of cutting the labor in half. The use of seminorms, ubiquitous in modern analysis, speeds things up even further. The book is intended for the reader who has some experience with proofs, a beginning graduate student for example. It might...

Overview of an Integrated Medical System for Exploration Missions

Science.gov (United States)

Watkins, Sharmila; Rubin, David

2013-01-01

The Exploration Medical Capability (ExMC) element of the NASA Human Research Program (HRP) is charged with addressing the risk of unacceptable health and mission outcomes due to limitations of inflight medical capabilities. The Exploration Medical System Demonstration (EMSD) is a project within the ExMC element aimed at reducing this risk by improving the medical capabilities available for exploration missions. The EMSD project will demonstrate, on the ground and on ISS, the integration of several components felt to be essential to the delivery of medical care during long ]duration missions outside of low Earth orbit. The components of the EMSD include the electronic medical record, assisted medical procedure software, medical consumables tracking technology and RFID ] tagged consumables, video conferencing capability, ultrasound device and probes (ground demonstration only), peripheral biosensors, and the software to allow communication among the various components (middleware). This presentation seeks to inform our international partners of the goals and objectives of the EMSD and to foster collaboration opportunities related to this and future projects.

An Integrated Dictionary-Learning Entropy-Based Medical Image Fusion Framework

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Guanqiu Qi

2017-10-01

Full Text Available Image fusion is widely used in different areas and can integrate complementary and relevant information of source images captured by multiple sensors into a unitary synthetic image. Medical image fusion, as an important image fusion application, can extract the details of multiple images from different imaging modalities and combine them into an image that contains complete and non-redundant information for increasing the accuracy of medical diagnosis and assessment. The quality of the fused image directly affects medical diagnosis and assessment. However, existing solutions have some drawbacks in contrast, sharpness, brightness, blur and details. This paper proposes an integrated dictionary-learning and entropy-based medical image-fusion framework that consists of three steps. First, the input image information is decomposed into low-frequency and high-frequency components by using a Gaussian filter. Second, low-frequency components are fused by weighted average algorithm and high-frequency components are fused by the dictionary-learning based algorithm. In the dictionary-learning process of high-frequency components, an entropy-based algorithm is used for informative blocks selection. Third, the fused low-frequency and high-frequency components are combined to obtain the final fusion results. The results and analyses of comparative experiments demonstrate that the proposed medical image fusion framework has better performance than existing solutions.

Psychiatry in the Harvard Medical School-Cambridge Integrated Clerkship: An Innovative, Year-Long Program

Science.gov (United States)

Griswold, Todd; Bullock, Christopher; Gaufberg, Elizabeth; Albanese, Mark; Bonilla, Pedro; Dvorak, Ramona; Epelbaum, Claudia; Givon, Lior; Kueppenbender, Karsten; Joseph, Robert; Boyd, J. Wesley; Shtasel, Derri

2012-01-01

Objective: The authors present what is to their knowledge the first description of a model for longitudinal third-year medical student psychiatry education. Method: A longitudinal, integrated psychiatric curriculum was developed, implemented, and sustained within the Harvard Medical School-Cambridge Integrated Clerkship. Curriculum elements…

Integration of Medical Imaging Including Ultrasound into a New Clinical Anatomy Curriculum

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Moscova, Michelle; Bryce, Deborah A.; Sindhusake, Doungkamol; Young, Noel

2015-01-01

In 2008 a new clinical anatomy curriculum with integrated medical imaging component was introduced into the University of Sydney Medical Program. Medical imaging used for teaching the new curriculum included normal radiography, MRI, CT scans, and ultrasound imaging. These techniques were incorporated into teaching over the first two years of the…

Integrating the Medical Home into the EHDI Process

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Munoz, Karen F.; Nelson, Lauri; Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd

2011-01-01

State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that examined 12 areas within state EHDI programs. Related to how the medical home is integrated into the EHDI process, 273 items were listed by 48 coordinators, and themes were identified…

Canadian National Guidelines and Recommendations for Integrating Career Advising Into Medical School Curricula.

Science.gov (United States)

Howse, Kelly; Harris, June; Dalgarno, Nancy

2017-11-01

Career planning, decision making about specialty choice, and preparation for residency matching are significant sources of stress for medical students. Attempts have been made to structure and formalize career advising by including it in accreditation standards. There is an expressed need for national guidelines on career advising for medical students. The Future of Medical Education in Canada Postgraduate (FMEC PG) Implementation Project was created to ensure Canadian medical trainees receive the best education possible. From this, a diverse sub-working group (SWG), representing different Canadian regions, was formed to review career advising processes across the country. The SWG developed, through a modified formal consensus methodology, a strategy for medical student career advising that is adaptable to all schools in alignment with existing accreditation standards. The SWG outlined five guiding principles and five essential elements for Canadian universities offering an MD degree with recommendations on how to integrate the elements into each school's career advising system. The five essential elements are a structured approach to career advising, information about available career options, elective guidance, preparation for residency applications, and social accountability. This Perspective endorses the view of the FMEC PG Implementation Project that national guidelines are important to ensure Canadian medical schools are consistently meeting accreditation standards by providing reliable and quality career advising to all medical students. The SWG's position, based on national and provincial feedback, is that these guidelines will stimulate discourse and action regarding the requirements and processes to carry out these recommendations nationwide and share across borders.

'Medical ethics'--an alternative approach.

Science.gov (United States)

Haldane, J J

1986-01-01

Contemporary medical ethics is generally concerned with the application of ethical theory to medico-moral dilemmas and with the critical analysis of the concepts of medicine. This paper presents an alternative programme: the development of a medical philosophy which, by taking as its starting point the two questions: what is man? and, what constitutes goodness in life? offers an account of health as one of the primary concepts of value. This view of the subject resembles that implied by ancient theories of goodness, and in later sections of the paper it is shown how Aristotle points us towards a coherent theory of human nature as psycho-physical, which overcomes the inadequacies of dualism and physicalist reductionism. What is on offer therefore, is the prospect of an integrated account of human nature and of what constitutes its flourishing: to be healthy is to be an active unity-of-parts in equilibrium. PMID:3761336

Educational outcomes of the Harvard Medical School-Cambridge integrated clerkship: a way forward for medical education.

Science.gov (United States)

Hirsh, David; Gaufberg, Elizabeth; Ogur, Barbara; Cohen, Pieter; Krupat, Edward; Cox, Malcolm; Pelletier, Stephen; Bor, David

2012-05-01

The authors report data from the Harvard Medical School-Cambridge Integrated Clerkship (CIC), a model of medical education in which students' entire third year consists of a longitudinal, integrated curriculum. The authors compare the knowledge, skills, and attitudes of students completing the CIC with those of students completing traditional third-year clerkships. The authors compared 27 students completing the first three years of the CIC (2004-2007) with 45 students completing clerkships at other Harvard teaching hospitals during the same period. At baseline, no significant between-group differences existed (Medical College Admission Test and Step 1 scores, second-year objective structured clinical examination [OSCE] performance, attitudes toward patient-centered care, and plans for future practice) in any year. The authors compared students' National Board of Medical Examiners Subject and Step 2 Clinical Knowledge scores, OSCE performance, perceptions of the learning environment, and attitudes toward patient-centeredness. CIC students performed as well as or better than their traditionally trained peers on measures of content knowledge and clinical skills. CIC students expressed higher satisfaction with the learning environment, more confidence in dealing with numerous domains of patient care, and a stronger sense of patient-centeredness. CIC students are at least as well as and in several ways better prepared than their peers. CIC students also demonstrate richer perspectives on the course of illness, more insight into social determinants of illness and recovery, and increased commitment to patients. These data suggest that longitudinal integrated clerkships offer students important intellectual, professional, and personal benefits.

Karet KB and jamu: an integrated approach to condom marketing.

Science.gov (United States)

Piet, D L; Hendrata, L

1974-01-01

The development of an out-of-clinic method for marketing condoms in Indonesia is described. A jamu company (jamu referes to any herbal medicant, many of which are related to sexual activity, whose use is firmly integrated into the Indonesian way of life) was contracted by the private, non-profit Prosperous Indonesia Foundation (YIS) to distribute condoms as a jamu item. The condoms are donated to YIS by the U.S. Agency for International Development, and are retailed at 20 rupees for a package of 3, with a profit of 4 rupees for the retailer. Mobile promotional/sales units are the most effective means for selling the devices. The approach appeals to the cultural and sexual character of the people. The media is used extensively to promote condoms and family planning. Although it is too early to assess the impact of the program, it is anticipated that this novel approach will spread the use of condoms to all areas of Indonesia.

The Integration of Children Dependent on Medical Technology into Public Schools

Science.gov (United States)

Raymond, Jill A.

2009-01-01

Advances in medicine have increased the survival rates of children with complex medical conditions, including those who are dependent on technology such as ventilators and tracheostomies. The process of integrating children dependent on medical technology into public schools requires the collaboration of a multidisciplinary team to ensure that…

High resolution integral holography using Fourier ptychographic approach.

Science.gov (United States)

Li, Zhaohui; Zhang, Jianqi; Wang, Xiaorui; Liu, Delian

2014-12-29

An innovative approach is proposed for calculating high resolution computer generated integral holograms by using the Fourier Ptychographic (FP) algorithm. The approach initializes a high resolution complex hologram with a random guess, and then stitches together low resolution multi-view images, synthesized from the elemental images captured by integral imaging (II), to recover the high resolution hologram through an iterative retrieval with FP constrains. This paper begins with an analysis of the principle of hologram synthesis from multi-projections, followed by an accurate determination of the constrains required in the Fourier ptychographic integral-holography (FPIH). Next, the procedure of the approach is described in detail. Finally, optical reconstructions are performed and the results are demonstrated. Theoretical analysis and experiments show that our proposed approach can reconstruct 3D scenes with high resolution.

Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach

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Davood Shishebori

2013-01-01

Full Text Available Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

Developing an integrated framework of problem-based learning and coaching psychology for medical education: a participatory research.

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Wang, Qing; Li, Huiping; Pang, Weiguo; Liang, Shuo; Su, Yiliang

2016-01-05

Medical schools have been making efforts to develop their own problem-based learning (PBL) approaches based on their educational conditions, human resources and existing curriculum structures. This study aimed to explore a new framework by integrating the essential features of PBL and coaching psychology applicable to the undergraduate medical education context. A participatory research design was employed. Four educational psychology researchers, eight undergraduate medical school students and two accredited PBL tutors participated in a four-month research programme. Data were collected through participatory observation, focus groups, semi-structured interviews, workshop documents and feedback surveys and then subjected to thematic content analysis. The triangulation of sources and member checking were used to ensure the credibility and trustworthiness of the research process. Five themes emerged from the analysis: current experience of PBL curriculum; the roles of and relationships between tutors and students; student group dynamics; development of self-directed learning; and coaching in PBL facilitation. On the basis of this empirical data, a systematic model of PBL and coaching psychology was developed. The findings highlighted that coaching psychology could be incorporated into the facilitation system in PBL. The integrated framework of PBL and coaching psychology in undergraduate medical education has the potential to promote the development of the learning goals of cultivating clinical reasoning ability, lifelong learning capacities and medical humanity. Challenges, benefits and future directions for implementing the framework are discussed in this paper.

Telemedicine and EHR Integrated Approach for An Effective E-Governance Healthcare Framework

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Alpana Kakkar

2017-05-01

Full Text Available In the recent years, people have been more inclined towards the use of technology to reduce human effort. Telemedicine is one such concept which has gained popularity among the people, providing them easy access to health care. Telemedicine refers to the concept of providing health care from a distance through an integrated approach using information and communication technology (ICT. India, being a geographically wide country has its difficulties when it comes to providing health care facilities to people belonging to the different regions. This is one of the few reasons why India is the best stage to introduce a concept like telemedicine. The use of this technology to counter the various challenges has been highly regarded and termed as something which can revolutionize the medical field. Integrating telemedicine with electronic health record (EHR, which is a digital document of a person’s medical history is said to be a perfect combination which can help improve clinical efficiency. The country has seen initiatives taken up by various organizations, with the main motive of connecting the rural to the urban. Through this paper, we have discussed the potential we have with this technology, and also propose an EHR integrated telemedicine model to make the best use of it in an emergency healthcare situation to help save lives. We have also touched a few factors which can help the government better the current health scenario.

A Semi-automated Approach to Improve the Efficiency of Medical Imaging Segmentation for Haptic Rendering.

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Banerjee, Pat; Hu, Mengqi; Kannan, Rahul; Krishnaswamy, Srinivasan

2017-08-01

The Sensimmer platform represents our ongoing research on simultaneous haptics and graphics rendering of 3D models. For simulation of medical and surgical procedures using Sensimmer, 3D models must be obtained from medical imaging data, such as magnetic resonance imaging (MRI) or computed tomography (CT). Image segmentation techniques are used to determine the anatomies of interest from the images. 3D models are obtained from segmentation and their triangle reduction is required for graphics and haptics rendering. This paper focuses on creating 3D models by automating the segmentation of CT images based on the pixel contrast for integrating the interface between Sensimmer and medical imaging devices, using the volumetric approach, Hough transform method, and manual centering method. Hence, automating the process has reduced the segmentation time by 56.35% while maintaining the same accuracy of the output at ±2 voxels.

The integration of Information and Communication Technology into medical practice.

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Lupiáñez-Villanueva, Francisco; Hardey, Michael; Torrent, Joan; Ficapal, Pilar

2010-07-01

To identify doctors' utilization of ICT; to develop and characterise a typology of doctors' utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice. An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken. Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as 'integrated doctors'. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled 'non-integrated doctors'. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an 'integrated doctor'. The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands. 2010 Elsevier Ireland Ltd. All rights reserved.

Medical Affairs Efficiency in Pharma – a Pragmatic Approach to Success

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José Aleixo Dias

2014-10-01

Full Text Available Along recent years Pharma operations became increasingly complex. Trying to adapt to the requests of a fast changing and demanding environment, companies moved from the standard medical, marketing and sales structure to a much more complex puzzle of units, departments, internal and external reporting lines. Along with these, the number of functions increased so much that titles became confused for customers as for colleagues. The number of systems and tools grew alike; some are useful while others not compatible or redundant. The medical structure which was minimal two decades ago, increased to meet the requirements for scientific evidence, both from prescribers and payers. The roles of these medical affairs (MA functions, the way these are organized, the processes of interaction with other relevant players, their contribution to capture insights and translate these into actions, their reporting lines and the impact generated for the business and to the customers, are very much under discussion. Companies have been adopting different models to respond to these needs, but the change is constant, showing that most probably, the best fit has not yet been reached. The customer facing medical is a natural strategic evolution of the traditional MA role, demonstrating value, business alignment, integration and governance, which are essential pillars in building customer partnerships. This article describes the situation, and discusses pragmatic approaches to some of the most common challenges and issues, aiming to contribute to the improvement and effectiveness of the MA operations.

Medical equipment management

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Willson, Keith; Tabakov, Slavik

2013-01-01

Know What to Expect When Managing Medical Equipment and Healthcare Technology in Your Organization As medical technology in clinical care becomes more complex, clinical professionals and support staff must know how to keep patients safe and equipment working in the clinical environment. Accessible to all healthcare professionals and managers, Medical Equipment Management presents an integrated approach to managing medical equipment in healthcare organizations. The book explains the underlying principles and requirements and raises awareness of what needs to be done and what questions to ask. I

Towards a Unified Approach to Information Integration - A review paper on data/information fusion

Energy Technology Data Exchange (ETDEWEB)

Whitney, Paul D.; Posse, Christian; Lei, Xingye C.

2005-10-14

Information or data fusion of data from different sources are ubiquitous in many applications, from epidemiology, medical, biological, political, and intelligence to military applications. Data fusion involves integration of spectral, imaging, text, and many other sensor data. For example, in epidemiology, information is often obtained based on many studies conducted by different researchers at different regions with different protocols. In the medical field, the diagnosis of a disease is often based on imaging (MRI, X-Ray, CT), clinical examination, and lab results. In the biological field, information is obtained based on studies conducted on many different species. In military field, information is obtained based on data from radar sensors, text messages, chemical biological sensor, acoustic sensor, optical warning and many other sources. Many methodologies are used in the data integration process, from classical, Bayesian, to evidence based expert systems. The implementation of the data integration ranges from pure software design to a mixture of software and hardware. In this review we summarize the methodologies and implementations of data fusion process, and illustrate in more detail the methodologies involved in three examples. We propose a unified multi-stage and multi-path mapping approach to the data fusion process, and point out future prospects and challenges.

Vertical integration of basic science in final year of medical education.

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Rajan, Sudha Jasmine; Jacob, Tripti Meriel; Sathyendra, Sowmya

2016-01-01

Development of health professionals with ability to integrate, synthesize, and apply knowledge gained through medical college is greatly hampered by the system of delivery that is compartmentalized and piecemeal. There is a need to integrate basic sciences with clinical teaching to enable application in clinical care. To study the benefit and acceptance of vertical integration of basic science in final year MBBS undergraduate curriculum. After Institutional Ethics Clearance, neuroanatomy refresher classes with clinical application to neurological diseases were held as part of the final year posting in two medical units. Feedback was collected. Pre- and post-tests which tested application and synthesis were conducted. Summative assessment was compared with the control group of students who had standard teaching in other two medical units. In-depth interview was conducted on 2 willing participants and 2 teachers who did neurology bedside teaching. Majority (>80%) found the classes useful and interesting. There was statistically significant improvement in the post-test scores. There was a statistically significant difference between the intervention and control groups' scores during summative assessment (76.2 vs. 61.8 P Vertical integration of basic science in final year was beneficial and resulted in knowledge gain and improved summative scores. The classes were found to be useful, interesting and thought to help in clinical care and application by majority of students.

Journal of Mind and Medical Sciences: translational and integrative mission

OpenAIRE

David L. Rowland; Ion G. Motofei

2017-01-01

Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci.) established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports. The journal adheres to the philosophy that high quality, original ideas and information should be readily accessibl...

Dynamic integration of residential building design and green energies : the Bireth approach : building integrated renewable energy total harvest approach

Energy Technology Data Exchange (ETDEWEB)

Cheung, K.P. [Hong Kong Univ., Hong Kong (China). Dept. of Architecture; Luk, C.L.P. [Chu Hai College of Higher Education, Hong Kong (China). Dept. of Architecture; Wong, S.T. [Hong Kong Univ., Hong Kong (China). Div. of Arts and Humanities, SPACE; Chung, S.L.; Fung, K.S.; Leung, M.F. [Hong Kong Inst. of Vocational Education, Hong Kong (China)

2006-07-01

Renewable energy sources that are commonly used in buildings include solar energy, wind energy and rainwater collection. High quality environmentally responsive residential buildings are designed to provide good insulation in winter and solar shading in summer. However, this study demonstrated that the green energy design in residential buildings is not usually well integrated. For example, windows with clear double or triple glazed glass, allow good penetration of sunlight during the day in winter, but are not further dynamically insulated for when the sun goes down to avoid heat loss from the building. Additionally, good solar static shading devices often block much needed daylight on cloudy winter days. These examples emphasize the lack of an integrated approach to gain the best advantage of green energies and to minimize energy costs in residential buildings. This study addressed issues facing the integrated approach with particular reference to the design of a small residential building in rural Beijing. The design included a new approach for interpreting a traditional Beijing court yard house in the modern Beijing rural context, while integrating multi-responding innovative green energy applications derived from first principles. This paper also presented a proposal for a village house in Hong Kong to harvest as much renewable energies as possible, primarily wind energy and solar energy, that come into contact with the building. The purpose was to work towards a renewable energy approach for buildings, namely the Bireth approach, which will benefit practically all houses by making them zero energy houses. The paper described the feasibility of integrating renewable energies in buildings to fulfill performance requirements such improving ventilation, providing warm interiors, drying clothes, or storing solar and wind energies into power batteries. The challenges facing the development of a proposed micro solar hot air turbine were also presented. 15 refs., 6

Student feedback about the integrated curriculum in a Caribbean medical school

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P. Ravi Shankar

2014-09-01

Full Text Available Purpose: Xavier University School of Medicine adopted an integrated, organ system-based curriculum in January 2013. The present study was aimed at determining students’ perceptions of the integrated curriculum and related assessment methods. Methods: The study was conducted on first- to fourth-semester undergraduate medical students during March 2014. The students were informed of the study and subsequently invited to participate. Focus group discussions were conducted. The curriculum’s level of integration, different courses offered, teaching-learning methods employed, and the advantages and concerns relating to the curriculum were noted. The respondents also provided feedback about the assessment methods used. Deductive content analysis was used to analyze the data. Results: Twenty-two of the 68 students (32.2% participated in the study. The respondents expressed generally positive opinions. They felt that the curriculum prepared them well for licensing examinations and future practice. Problem-based learning sessions encouraged active learning and group work among students, thus, improving their understanding of the course material. The respondents felt that certain subjects were allocated a larger proportion of time during the sessions, as well as more questions during the integrated assessment. They also expressed an appreciation for medical humanities, and felt that sessions on the appraisal of literature needed modification. Their opinions about assessment of behavior, attitudes, and professionalism varied. Conclusion: Student opinion was positive, overall. Our findings would be of interest to other medical schools that have recently adopted an integrated curriculum or are in the process of doing so.

Evaluating and Predicting Patient Safety for Medical Devices With Integral Information Technology

Science.gov (United States)

2005-01-01

323 Evaluating and Predicting Patient Safety for Medical Devices with Integral Information Technology Jiajie Zhang, Vimla L. Patel, Todd R...errors are due to inappropriate designs for user interactions, rather than mechanical failures. Evaluating and predicting patient safety in medical ...the users on the identified trouble spots in the devices. We developed two methods for evaluating and predicting patient safety in medical devices

On Line Service Composition in the Integrated Clinical Environment for eHealth and Medical Systems.

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García-Valls, Marisol; Touahria, Imad Eddine

2017-06-08

Medical and eHealth systems are progressively realized in the context of standardized architectures that support safety and ease the integration of the heterogeneous (and often proprietary) medical devices and sensors. The Integrated Clinical Environment (ICE) architecture appeared recently with the goal of becoming a common framework for defining the structure of the medical applications as concerns the safe integration of medical devices and sensors. ICE is simply a high level architecture that defines the functional blocks that should be part of a medical system to support interoperability. As a result, the underlying communication backbone is broadly undefined as concerns the enabling software technology (including the middleware) and associated algorithms that meet the ICE requirements of the flexible integration of medical devices and services. Supporting the on line composition of services in a medical system is also not part of ICE; however, supporting this behavior would enable flexible orchestration of functions (e.g., addition and/or removal of services and medical equipment) on the fly. iLandis one of the few software technologies that supports on line service composition and reconfiguration, ensuring time-bounded transitions across different service orchestrations; it supports the design, deployment and on line reconfiguration of applications, which this paper applies to service-based eHealth domains. This paper designs the integration between ICE architecture and iLand middleware to enhance the capabilities of ICE with on line service composition and the time-bounded reconfiguration of medical systems based on distributed services. A prototype implementation of a service-based eHealth system for the remote monitoring of patients is described; it validates the enhanced capacity of ICE to support dynamic reconfiguration of the application services. Results show that the temporal cost of the on line reconfiguration of the eHealth application is bounded

Medical device integration: CIOs must bridge the digital divide between devices and electronic medical records.

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Raths, David

2009-02-01

To get funding approved for medical device integration, ClOs suggest focusing on specific patient safety or staff efficiency pain points. Organizations that make clinical engineering part of their IT team report fewer chain-of-command issues. It also helps IT people understand the clinical goals because the engineering people have been working closely with clinicians for years. A new organization has formed to work on collaboration between clinical engineers and IT professionals. For more information, go to www.ceitcollaboration.org. ECRI Institute has written a guide to handling the convergence of medical technology and hospital networks. Its "Medical Technology for the IT Professional: An Essential Guide for Working in Today's Healthcare Setting" also details how IT professionals can assist hospital technology planning and acquisition, and provide ongoing support for IT-based medical technologies. For more information, visit www.ecri.org/ITresource.

How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach.

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Duke, Pamela; Frankel, Richard M; Reis, Shmuel

2013-01-01

Implementation of the electronic health record (EHR) has changed the dynamics of doctor-patient communication. Physicians train to use EHRs from a technical standpoint, giving only minimal attention to integrating the human dimensions of the doctor-patient relationship into the computer-accompanied medical visit. This article reviews the literature and proposes a model to help clinicians, residents, and students improve physician-patient communication while using the EHR. We conducted a literature search on use of communication skills when interfacing with the EHR. We observed an instructional gap and developed a model using evidence-based communication skills. This model integrates patient-centered interview skills and aims to empower physicians to remain patient centered while effectively using EHRs. It may also serve as a template for future educational and practice interventions for use of the EHR in the examination room.

Models for integrating medical acupuncture into practice: an exploratory qualitative study of physicians' experiences.

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Crumley, Ellen T

2016-08-01

Internationally, physicians are integrating medical acupuncture into their practice. Although there are some informative surveys and reviews, there are few international, exploratory studies detailing how physicians have accommodated medical acupuncture (eg, by modifying schedules, space and processes). To examine how physicians integrate medical acupuncture into their practice. Semi-structured interviews and participant observations of physicians practising medical acupuncture were conducted using convenience and snowball sampling. Data were analysed in NVivo and themes were developed. Despite variation, three principal models were developed to summarise the different ways that physicians integrated medical acupuncture into their practice, using the core concept of 'helping'. Quotes were used to illustrate each model and its corresponding themes. There were 25 participants from 11 countries: 21 agreed to be interviewed and four engaged in participant observations. Seventy-two per cent were general practitioners. The three models were: (1) appointments (44%); (2) clinics (44%); and (3) full-time practice (24%). Some physicians held both appointments and regular clinics (models 1 and 2). Most full-time physicians initially tried appointments and/or clinics. Some physicians charged to offset administration costs or compensate for their time. Despite variation within each category, the three models encapsulated how physicians described their integration of medical acupuncture. Physicians varied in how often they administered medical acupuncture and the amount of time they spent with patients. Although 24% of physicians surveyed administered medical acupuncture full-time, most practised it part-time. Each individual physician incorporated medical acupuncture in the way that worked best for their practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Integrating geriatrics into medical school: student journaling as an innovative strategy for evaluating curriculum.

Science.gov (United States)

Shield, Renée R; Farrell, Timothy W; Nanda, Aman; Campbell, Susan E; Wetle, Terrie

2012-02-01

The Alpert Medical School of Brown University began to integrate geriatrics content into all preclerkship courses and key clerkship cases as part of a major medical school curriculum redesign in 2006. This study evaluates students' responses to geriatrics integration within the curriculum using journals kept by volunteer preclerkship and clerkship students between 2007 and 2010. The journals were used to assess the quality of curricular integration of geriatrics didactic and clinical content, to gather information for shaping the evolving curriculum, and to elicit students' responses about their professional development and caring for older adults. Student "journalers" wrote narrative reactions to and evaluations of aging-related content and exposure to older patients in response to written semistructured questions. An interdisciplinary team (including a health services researcher, gerontologist, medical anthropologist, and 2 geriatricians) used qualitative analysis to code the 405 journal entries. The team identified 10 themes within the following domains: (a) evaluation of efforts to integrate geriatrics within the medical school curriculum, (b) recognition and application of geriatrics principles, (c) student attitudes and cultural experiences regarding aging and the care of older patients, and (d) personal and professional development over time. Themes emerging within these domains reflect the effectiveness of geriatrics integration within the new curriculum as well as students' professional development. Journaling provides a novel and effective method for capturing medical students' responses to curricular content in real time, allowing for midcourse corrections and identifying key components of their professional development.

Learning mechanisms to limit medication administration errors.

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Drach-Zahavy, Anat; Pud, Dorit

2010-04-01

This paper is a report of a study conducted to identify and test the effectiveness of learning mechanisms applied by the nursing staff of hospital wards as a means of limiting medication administration errors. Since the influential report ;To Err Is Human', research has emphasized the role of team learning in reducing medication administration errors. Nevertheless, little is known about the mechanisms underlying team learning. Thirty-two hospital wards were randomly recruited. Data were collected during 2006 in Israel by a multi-method (observations, interviews and administrative data), multi-source (head nurses, bedside nurses) approach. Medication administration error was defined as any deviation from procedures, policies and/or best practices for medication administration, and was identified using semi-structured observations of nurses administering medication. Organizational learning was measured using semi-structured interviews with head nurses, and the previous year's reported medication administration errors were assessed using administrative data. The interview data revealed four learning mechanism patterns employed in an attempt to learn from medication administration errors: integrated, non-integrated, supervisory and patchy learning. Regression analysis results demonstrated that whereas the integrated pattern of learning mechanisms was associated with decreased errors, the non-integrated pattern was associated with increased errors. Supervisory and patchy learning mechanisms were not associated with errors. Superior learning mechanisms are those that represent the whole cycle of team learning, are enacted by nurses who administer medications to patients, and emphasize a system approach to data analysis instead of analysis of individual cases.

An integrated artificial neural networks approach for predicting global radiation

International Nuclear Information System (INIS)

Azadeh, A.; Maghsoudi, A.; Sohrabkhani, S.

2009-01-01

This article presents an integrated artificial neural network (ANN) approach for predicting solar global radiation by climatological variables. The integrated ANN trains and tests data with multi layer perceptron (MLP) approach which has the lowest mean absolute percentage error (MAPE). The proposed approach is particularly useful for locations where no available measurement equipment. Also, it considers all related climatological and meteorological parameters as input variables. To show the applicability and superiority of the integrated ANN approach, monthly data were collected for 6 years (1995-2000) in six nominal cities in Iran. Separate model for each city is considered and the quantity of solar global radiation in each city is calculated. Furthermore an integrated ANN model has been introduced for prediction of solar global radiation. The acquired results of the integrated model have shown high accuracy of about 94%. The results of the integrated model have been compared with traditional angstrom's model to show its considerable accuracy. Therefore, the proposed approach can be used as an efficient tool for prediction of solar radiation in the remote and rural locations with no direct measurement equipment.

An integrative approach to cultural competence in the psychiatric curriculum.

Science.gov (United States)

Fung, Kenneth; Andermann, Lisa; Zaretsky, Ari; Lo, Hung-Tat

2008-01-01

As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country. The authors conducted a systematic review of cultural competence by searching databases including PubMed, PsycINFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate "integrative" approach with a mindful, balanced emphasis on both generic and specific cultural competencies. Learning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (CanMEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program's emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive. The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

The Ambulatory Integration of the Medical and Social (AIMS) model: A retrospective evaluation.

Science.gov (United States)

Rowe, Jeannine M; Rizzo, Victoria M; Shier Kricke, Gayle; Krajci, Kate; Rodriguez-Morales, Grisel; Newman, Michelle; Golden, Robyn

2016-01-01

An exploratory, retrospective evaluation of Ambulatory Integration of the Medical and Social (AIMS), a care coordination model designed to integrate medical and non-medical needs of patients and delivered exclusively by social workers was conducted to examine mean utilization of costly health care services for older adult patients. Results reveal mean utilization of 30-day hospital readmissions, emergency department (ED) visits, and hospital admissions are significantly lower for the study sample compared to the larger patient population. Comparisons with national population statistics reveal significantly lower mean utilization of 30-day admissions and ED visits for the study sample. The findings offer preliminary support regarding the value of AIMS.

Critical perspectives of pedagogical approaches to reversing the order of integration in double integrals

Science.gov (United States)

Tisdell, Christopher C.

2017-11-01

This paper presents some critical perspectives regarding pedagogical approaches to the method of reversing the order of integration in double integrals from prevailing educational literature on multivariable calculus. First, we question the message found in popular textbooks that the traditional process of reversing the order of integration is necessary when solving well-known problems. Second, we illustrate that the method of integration by parts can be directly applied to many of the classic pedagogical problems in the literature concerning double integrals, without taking the well-worn steps associated with reversing the order of integration. Third, we examine the benefits and limitations of such a method. In our conclusion, we advocate for integration by parts to be a part of the pedagogical conversation in the learning and teaching of double integral methods; and call for more debate around its use in the learning and teaching of other areas of mathematics. Finally, we emphasize the need for critical approaches in the pedagogy of mathematics more broadly.

[Display technologies for augmented reality in medical applications].

Science.gov (United States)

Eck, Ulrich; Winkler, Alexander

2018-04-01

One of the main challenges for modern surgery is the effective use of the many available imaging modalities and diagnostic methods. Augmented reality systems can be used in the future to blend patient and planning information into the view of surgeons, which can improve the efficiency and safety of interventions. In this article we present five visualization methods to integrate augmented reality displays into medical procedures and the advantages and disadvantages are explained. Based on an extensive literature review the various existing approaches for integration of augmented reality displays into medical procedures are divided into five categories and the most important research results for each approach are presented. A large number of mixed and augmented reality solutions for medical interventions have been developed as research prototypes; however, only very few systems have been tested on patients. In order to integrate mixed and augmented reality displays into medical practice, highly specialized solutions need to be developed. Such systems must comply with the requirements with respect to accuracy, fidelity, ergonomics and seamless integration into the surgical workflow.

Bridging the Chasm: Challenges, Opportunities, and Resources for Integrating a Dissemination and Implementation Science Curriculum into Medical Education.

Science.gov (United States)

Ginossar, Tamar; Heckman, Carolyn J; Cragun, Deborah; Quintiliani, Lisa M; Proctor, Enola K; Chambers, David A; Skolarus, Ted; Brownson, Ross C

2018-01-01

Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical education, describe challenges to implementing such training, and provide strategies and resources for building D&I capacity. We conducted (1) a systematic review to identify US-based D&I training efforts and (2) a critical review of additional literature to inform our evaluation of the challenges and opportunities of integrating D&I training in medical education. Out of 269 unique articles reviewed, 11 described US-based D&I training. Although vibrant and diverse training opportunities exist, their capacity is limited, and they are not designed to meet physicians' needs. Synthesis of relevant literature using a critical review approach identified challenges inherent to changing medical education, as well as challenges related to D&I science. Finally, selected strategies and resources are available for facilitating incorporation of D&I training into medical education and overcoming existing challenges. Integrating D&I training in the medical education curriculum, and particularly in residency and fellowship training, holds promise for bridging the chasm between scientific discoveries and improved patient care and outcomes. However, unique challenges should be addressed, including the need for greater evidence.

The theory of planned behaviour in medical education: a model for integrating professionalism training.

Science.gov (United States)

Archer, Ray; Elder, William; Hustedde, Carol; Milam, Andrea; Joyce, Jennifer

2008-08-01

Teaching and evaluating professionalism remain important issues in medical education. However, two factors hinder attempts to integrate curricular elements addressing professionalism into medical school training: there is no common definition of medical professionalism used across medical education, and there is no commonly accepted theoretical model upon which to integrate professionalism into the curriculum. This paper proposes a definition of professionalism, examines this definition in the context of some of the previous definitions of professionalism and connects this definition to the attitudinal roots of professionalism. The problems described above bring uncertainty about the best content and methods with which to teach professionalism in medical education. Although various aspects of professionalism have been incorporated into medical school curricula, content, teaching and evaluation remain controversial. We suggest that intervening variables, which may augment or interfere with medical students' implementation of professionalism knowledge, skills and, therefore, attitudes, may go unaddressed. We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students' perceived control over their behaviours.

Empathy in Medical Students: Exploring the Impact of a Longitudinal Integrated Clerkship Model

Science.gov (United States)

Bergstresser, Kara

2017-01-01

Empathy is considered a significant factor in the physician-patient relationship. The current study examined the impact of a Longitudinal Integrated Clerkship (LIC) model on empathy and patient-centered attitude in medical students. Archival data were examined from 186 medical students at a medical college in the mid-Atlantic region of the United…

RISK INTEGRATION MECHANISMS AND APPROACHES IN BANKING INDUSTRY

OpenAIRE

JIANPING LI; JICHUANG FENG; XIAOLEI SUN; MINGLU LI

2012-01-01

Recently, the number of consultative documents and research papers that discuss risk integration has grown considerably. This paper presents a comprehensive review of the work done on risk integration in the banking industry. This survey includes: (1) risk integration methods within regulatory frameworks and the banking industry; (2) challenges of risk integration; (3) risk interaction mechanisms; (4) development of risk integration approaches; (5) risk interaction results: diversification ve...

HeartMath and Ubuntu integral healing approaches for social ...

African Journals Online (AJOL)

HeartMath and Ubuntu integral healing approaches for social coherence and physical activity. Stephen D. Edwards. Abstract. This research was motivated by many social health problems confronting planet earth. Its aim is to introduce HeartMath and Ubuntu as complimentary, integral healing approaches for promoting ...

Functional integral approach to classical statistical dynamics

International Nuclear Information System (INIS)

Jensen, R.V.

1980-04-01

A functional integral method is developed for the statistical solution of nonlinear stochastic differential equations which arise in classical dynamics. The functional integral approach provides a very natural and elegant derivation of the statistical dynamical equations that have been derived using the operator formalism of Martin, Siggia, and Rose

Regional Integrated Silvopastoral Approaches to Ecosystem Management Project

OpenAIRE

CIPAV (Centre For Research on Sustainable Agricultural Production Systems); CATIE (Centro Agronomico Tropical de Investigacion y Ensenanza); NITLAPAN

2007-01-01

Metadata only record The Regional Integrated Silvopastoral Approaches to Ecosystem Management Project introduces the payment for environmental services approach to silvopastoral farmers in Colombia, Costa Rica, and Nicaragua. The objectives of the project are to "demonstrate and measure a) the effects the introduction of payment incentives for environmental services to farmers on their adoption of integrated silvopastoral farming systems in degraded pasture lands; and b) the resulting impr...

Statistical inference an integrated Bayesianlikelihood approach

CERN Document Server

Aitkin, Murray

2010-01-01

Filling a gap in current Bayesian theory, Statistical Inference: An Integrated Bayesian/Likelihood Approach presents a unified Bayesian treatment of parameter inference and model comparisons that can be used with simple diffuse prior specifications. This novel approach provides new solutions to difficult model comparison problems and offers direct Bayesian counterparts of frequentist t-tests and other standard statistical methods for hypothesis testing.After an overview of the competing theories of statistical inference, the book introduces the Bayes/likelihood approach used throughout. It pre

A new Gauss quadrature for multicentre integrals over STOs in the Gaussian integral transform approach

International Nuclear Information System (INIS)

Bouferguene, Ahmed

2005-01-01

When computing multicentre integrals over Slater-type orbitals (STOs) by means of the Shavitt and Karplus Gaussian integral transforms (Shavitt and Karplus 1962 J. Chem. Phys. 36 550), one usually ends up with a multiple integral of the form ∫ 0 1 du ∫ 0 1 dv ...∫ 0 ∞ dz F(u, v, ..., z) (Shavitt and Karplus 1965 J. Chem. Phys. 43 398) in which all the integrals are inter-related. The most widely used approach for computing such an integral is to apply a product of Gauss-Legendre quadratures for the integrals over [0, 1] while the semi-infinite term is evaluated by a special procedure. Although numerous approaches have been developed to accurately perform the integration over [0, ∞) efficiently, it is the aim of this work to add a new tool that could be of some benefit in carrying out the hard task of multicentre integrals over STOs. The new approach relies on a special Gauss quadrature referred to as Gauss-Bessel to accurately evaluate the semi-infinite integral of interest. In this work, emphasis is put on accuracy rather than efficiency since its aim is essentially to bring a proof of concept showing that Gauss-Bessel quadrature can successfully be applied in the context of multicentre integrals over STOs. The obtained accuracy is comparable to that obtained with other methods available in the literature

Integration of the HTC Vive into the medical platform MeVisLab

Science.gov (United States)

Egger, Jan; Gall, Markus; Wallner, Jürgen; de Almeida Germano Boechat, Pedro; Hann, Alexander; Li, Xing; Chen, Xiaojun; Schmalstieg, Dieter

2017-03-01

Virtual Reality (VR) is an immersive technology that replicates an environment via computer-simulated reality. VR gets a lot of attention in computer games but has also great potential in other areas, like the medical domain. Examples are planning, simulations and training of medical interventions, like for facial surgeries where an aesthetic outcome is important. However, importing medical data into VR devices is not trivial, especially when a direct connection and visualization from your own application is needed. Furthermore, most researcher don't build their medical applications from scratch, rather they use platforms, like MeVisLab, Slicer or MITK. The platforms have in common that they integrate and build upon on libraries like ITK and VTK, further providing a more convenient graphical interface to them for the user. In this contribution, we demonstrate the usage of a VR device for medical data under MeVisLab. Therefore, we integrated the OpenVR library into MeVisLab as an own module. This enables the direct and uncomplicated usage of head mounted displays, like the HTC Vive under MeVisLab. Summarized, medical data from other MeVisLab modules can directly be connected per drag-and-drop to our VR module and will be rendered inside the HTC Vive for an immersive inspection.

A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency.

Science.gov (United States)

O'Heron, Colette T; Jarman, Benjamin T

2014-01-01

To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Self-Referent Constructs and Medical Sociology: In Search of an Integrative Framework*

Science.gov (United States)

Kaplan, Howard B.

2010-01-01

A theoretical framework centering on four classes of self-referent constructs is offered as a device for integrating the diverse areas constituting medical sociology. Guidance by this framework sensitizes the researcher to the occurrence of parallel processes in adjacent disciplines, facilitates recognition of the etiological significance of findings from other disciplines for explaining medical sociological phenomena, and encourages transactions between sociology and medical sociology whereby each informs and is informed by the other. PMID:17583268

Integration of SNOMED CT into the OpenMRS electronic medical record system framework

CSIR Research Space (South Africa)

Gerber, A

2008-11-01

Full Text Available Integrating a mechanism to store, retrieve and use clinical data with a system to manage medical records enables better utilisation of medical data and improved healthcare. This poster introduces a research project that aims to extend Open...

Science Teachers’ Pedagogical Content Knowledge and Integrated Approach

Science.gov (United States)

Adi Putra, M. J.; Widodo, A.; Sopandi, W.

2017-09-01

The integrated approach refers to the stages of pupils’ psychological development. Unfortunately, the competences which are designed into the curriculum is not appropriate with the child development. This Manuscript presents PCK (pedagogical content knowledge) of teachers who teach science content utilizing an integrated approach. The data has been collected by using CoRe, PaP-eR, and interviews from six elementary teachers who teach science. The paper informs that high and stable teacher PCKs have an impact on how teachers present integrated teaching. Because it is influenced by the selection of important content that must be submitted to the students, the depth of the content, the reasons for choosing the teaching procedures and some other things. So for teachers to be able to integrate teaching, they should have a balanced PCK.

Integrated, regional approach to risk management of industrial systems

International Nuclear Information System (INIS)

Chakraborty, S.

1992-01-01

This paper focuses on the following four main issues: (1) necessity for an integrated, regional approach to risk management of industrial systems; (2) principles of risk management; (3) integrated approach and overall methodology; and (4) implementation of risk management strategies on a regional basis. The U.N. Interagency project on risk management for large industrial areas, which is a pioneer type of international initiative for an integrated approach to risk management, is discussed in this context. Another encouraging activity for further development of overall methodologies for risk management is the ongoing project on the risk and safety of technical systems at the Swiss Federal Institute of Technology in Aurich. The concept of integral risk management takes into account multidimensional factors including technical, economic, political, social, and ethical considerations to allow a well-balanced decision-making process

A structured approach to medical comanagement of surgical patients

Directory of Open Access Journals (Sweden)

Eric Siegal

2012-12-01

Full Text Available Comanagement is defined as shared responsibility, authority and accountability for the management of a hospitalized patient, and represents a fundamentally different model from traditional medical consultation. Medical comanagement has rapidly proliferated and is now a dominant model of care in American hospitals. Comanagement is most effective when patients are appropriately selected, processes are predetermined and systems are implemented to ensure rigorous and continuous improvement. This article provides a structured approach for conceptualizing and implementing medical comanagement.

National electronic medical records integration on cloud computing system.

Science.gov (United States)

Mirza, Hebah; El-Masri, Samir

2013-01-01

Few Healthcare providers have an advanced level of Electronic Medical Record (EMR) adoption. Others have a low level and most have no EMR at all. Cloud computing technology is a new emerging technology that has been used in other industry and showed a great success. Despite the great features of Cloud computing, they haven't been utilized fairly yet in healthcare industry. This study presents an innovative Healthcare Cloud Computing system for Integrating Electronic Health Record (EHR). The proposed Cloud system applies the Cloud Computing technology on EHR system, to present a comprehensive EHR integrated environment.

Integration of basic science and clinical medicine: the innovative approach of the cadaver biopsy project at the Boston University School of Medicine.

Science.gov (United States)

Eisenstein, Anna; Vaisman, Lev; Johnston-Cox, Hillary; Gallan, Alexander; Shaffer, Kitt; Vaughan, Deborah; O'Hara, Carl; Joseph, Lija

2014-01-01

Curricular integration has emerged as a consistent theme in medical education reform. Vertical integration of topics such as pathology offers the potential to bring basic science content into the clinical arena, but faculty/student acceptance and curricular design pose challenges for such integration. The authors describe the Cadaver Biopsy Project (CBP) at Boston University School of Medicine as a sustainable model of vertical integration. Faculty and select senior medical students obtained biopsies of cadavers during the first-year gross anatomy course (fall 2009) and used these to develop clinical cases for courses in histology (spring 2010), pathology (fall 2010-spring 2011), and radiology (fall 2011 or spring 2012), thereby linking students' first experiences in basic sciences with other basic science courses and later clinical courses. Project goals included engaging medical stu dents in applying basic science princi ples in all aspects of patient care as they acquire skills. The educational intervention used a patient (cadaver)-centered approach and small-group, collaborative, case-based learning. Through this project, the authors involved clinical and basic science faculty-plus senior medical students-in a collaborative project to design and implement an integrated curriculum through which students revisited, at several different points, the microscopic structure and pathophysiology of common diseases. Developing appropriate, measurable out comes for medical education initiatives, including the CBP, is challenging. Accumu lation of qualitative feedback from surveys will guide continuous improvement of the CBP. Documenting longer-term impact of the curricular innovation on test scores and other competency-based outcomes is an ultimate goal.

Medical psychotherapy of schizophrenia--a dynamic/supportive approach.

Science.gov (United States)

Corradi, Richard B

2004-01-01

Split psychiatric treatment-a psychiatrist prescribing medication while a nonphysician provides or coordinates psychosocial treatments-is common practice, especially in the managed care setting. This influence, along with a focus on the biology of mental illness, has shifted the emphasis in psychiatric education and practice away from psychotherapy. In particular, "psychotherapy" of schizophrenia has gotten short shrift. Since our drugs for schizophrenia do not cure, but only ameliorate, it would be unfortunate if psychiatrists were to become marginalized in a largely prescriptive role. This paper discusses medical psychotherapy of schizophrenia-an integrated treatment in which the psychiatrist provides the comprehensive care that such a chronic biopsychosocial illness requires.

An Integrated Approach to Biology

Indian Academy of Sciences (India)

Home; Journals; Resonance – Journal of Science Education; Volume 16; Issue 8. An Integrated Approach to Biology. Aniket Bhattacharya. General Article Volume 16 Issue 8 August 2011 pp 742-753. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/016/08/0742-0753 ...

Social network approaches to recruitment, HIV prevention, medical care, and medication adherence.

Science.gov (United States)

Latkin, Carl A; Davey-Rothwell, Melissa A; Knowlton, Amy R; Alexander, Kamila A; Williams, Chyvette T; Boodram, Basmattee

2013-06-01

This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.

User experience integrated life-style cloud-based medical application.

Science.gov (United States)

Serban, Alexandru; Lupşe, Oana Sorina; Stoicu-Tivadar, Lăcrămioara

2015-01-01

Having a modern application capable to automatically collect and process data from users, based on information and lifestyle answers is one of current challenges for researchers and medical science. The purpose of the current study is to integrate user experience design (UXD) in a cloud-based medical application to improve patient safety, quality of care and organizational efficiency. The process consists of collecting traditional and new data from patients and users using online questionnaires. A questionnaire dynamically asks questions about the user's current diet and lifestyle. After the user will introduce the data, the application will formulate a presumptive nutritional plan and will suggest different medical recommendations regarding a healthy lifestyle, and calculates a risk factor for diseases. This software application, by design and usability will be an efficient tool dedicated for fitness, nutrition and health professionals.

Complementary medicines in medicine: Conceptualising terminology among Australian medical students using a constructivist grounded theory approach.

Science.gov (United States)

Templeman, Kate; Robinson, Anske; McKenna, Lisa

2015-02-01

Terminology around the use of complementary medicines (CM) within medical discourse is ambiguous. Clear collective discourse within the medical context is required. This study reports the findings of a Constructivist Grounded Theory Method study used to explore medical students' conceptualisation of terminology and associated value components around CMs as evidenced within their discourse community. The results show that terminology surrounding CMs within medicine is politically charged and fraught with value judgements. Terms used to describe CMs were considered, many of which were deemed problematic. Categorisation of specific medicines was also deemed inappropriate in certain contexts. Conceptualisation of CM terminology, categorisation and value implications, discriminated between levels of evidence for CMs and provided insights into the social change of medicine towards emergence of an evidence-based integrative approach. The results show that terminology surrounding CM is a social construct consistent with fluid conceptualisation and operationalisation in different social contexts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Bringing political ecology into critical medical anthropology: a challenge to biocultural approaches.

Science.gov (United States)

Baer, H A

1996-12-01

This essay presents an effort to incorporate the "environment" into critical medical anthropology. Rather than relying upon the multifactorial approach characteristic of medical ecology or biocultural approaches in medical anthropology, it urges critical medical anthropologists to turn to the burgeoning literature on eco-Marxism, eco-socialism, or political ecology in their efforts to develop a political ecology of health. Given that political ecologists generally advocate democratic eco-socialism as a meaningful alternative to the capitalist world system, this essay also presents a critical examination of the environmental record of post-revolutionary societies.

Critical Perspectives of Pedagogical Approaches to Reversing the Order of Integration in Double Integrals

Science.gov (United States)

Tisdell, Christopher C.

2017-01-01

This paper presents some critical perspectives regarding pedagogical approaches to the method of reversing the order of integration in double integrals from prevailing educational literature on multivariable calculus. First, we question the message found in popular textbooks that the traditional process of reversing the order of integration is…

THE FEMINIST APPROACH TO PSYCHOTHERAPY INTEGRATION

Directory of Open Access Journals (Sweden)

Lorena Božac Deležan

2011-12-01

Full Text Available The goal of Integrative Psychotherapy is to establish full inner and external contact (Moursund & Erskine, 2004. The most important goal in feminist therapy is the transformation of an individual as well as the transformation of the society as a whole (Herlihy & Corey, 2004. In my work I attempt to integrate both: to help the client establish inner and external contact, but also help him/her to become aware and recognize inner messages connected with his/her gender and replace them with constructive beliefs of his/her own, as well as for him/her to learn, regardless of his/her gender, to trust his/her intuition and experience. In this article I present my approach to integration in psychotherapy and the way I use feminist principles in Integrative Psychotherapy.

Machine learning approaches in medical image analysis

DEFF Research Database (Denmark)

de Bruijne, Marleen

2016-01-01

Machine learning approaches are increasingly successful in image-based diagnosis, disease prognosis, and risk assessment. This paper highlights new research directions and discusses three main challenges related to machine learning in medical imaging: coping with variation in imaging protocols......, learning from weak labels, and interpretation and evaluation of results....

Exploration Medical Cap Ability System Engineering Overview

Science.gov (United States)

McGuire, K.; Mindock, J.

2018-01-01

Deep Space Gateway and Transport missions will change the way NASA currently practices medicine. The missions will require more autonomous capability compared to current low Earth orbit operations. For the medical system, lack of consumable resupply, evacuation opportunities, and real-time ground support are key drivers toward greater autonomy. Recognition of the limited mission and vehicle resources available to carry out exploration missions motivates the Exploration Medical Capability (ExMC) Element's approach to enabling the necessary autonomy. The ExMC Systems Engineering team's mission is to "Define, develop, validate, and manage the technical system design needed to implement exploration medical capabilities for Mars and test the design in a progression of proving grounds." The Element's work must integrate with the overall exploration mission and vehicle design efforts to successfully provide exploration medical capabilities. ExMC is using Model-Based System Engineering (MBSE) to accomplish its integrative goals. The MBSE approach to medical system design offers a paradigm shift toward greater integration between vehicle and the medical system, and directly supports the transition of Earth-reliant ISS operations to the Earth-independent operations envisioned for Mars. This talk will discuss how ExMC is using MBSE to define operational needs, decompose requirements and architecture, and identify medical capabilities needed to support human exploration. How MBSE is being used to integrate across disciplines and NASA Centers will also be described. The medical system being discussed in this talk is one system within larger habitat systems. Data generated within the medical system will be inputs to other systems and vice versa. This talk will also describe the next steps in model development that include: modeling the different systems that comprise the larger system and interact with the medical system, understanding how the various systems work together, and

An integrated view of complex landscapes: a big data-model integration approach to trans-disciplinary science

Science.gov (United States)

The Earth is a complex system comprised of many interacting spatial and temporal scales. Understanding, predicting, and managing for these dynamics requires a trans-disciplinary integrated approach. Although there have been calls for this integration, a general approach is needed. We developed a Tra...

Advancing medical education: connecting interprofessional collaboration and education opportunities with integrative medicine initiatives to build shared learning.

Science.gov (United States)

Templeman, Kate; Robinson, Anske; McKenna, Lisa

2016-12-01

BackgroundImproved teamwork between conventional and complementary medicine (CM) practitioners is indicated to achieve effective healthcare. However, little is known about interprofessional collaboration and education in the context of integrative medicine (IM). MethodsThis paper reports the findings from a constructivist-grounded theory method study that explored and highlighted Australian medical students' experiences and opportunities for linking interprofessional collaboration and learning in the context of IM. Following ethical approval, in-depth semi-structured interviews were conducted with 30 medical students from 10 medical education faculties across Australian universities. Results Medical students recognised the importance of interprofessional teamwork between general medical practitioners and CM professionals in patient care and described perspectives of shared responsibilities, profession-specific responsibilities, and collaborative approaches within IM. While students identified that limited interprofessional collaboration currently occurred in the medical curriculum, interprofessional education was considered a means of increasing communication and collaboration between healthcare professionals, helping coordinate effective patient care, and understanding each healthcare team members' professional role and value. Conclusions The findings suggest that medical curricula should include opportunities for medical students to develop required skills, behaviours, and attitudes for interprofessional collaboration and interprofessional education within the context of IM. While this is a qualitative study that reflects theoretical saturation from a selected cohort of medical students, the results also point to the importance of including CM professionals within interprofessional collaboration, thus contributing to more person-centred care.

Approaches to the summability of divergent multidimensional integrals

International Nuclear Information System (INIS)

Vainikko, G M; Lifanov, I K

2003-01-01

Under discussion are various approaches to the concept of summability (finding the finite part - (f.p.)) of divergent integrals with integrand represented as a product of two functions, one with a parameter-dependent non-integrable singularity at one point of the integration and the other absolutely integrable. A study is made of summability methods which are based on the expansion of the absolutely integrable function in a Taylor series with centre at the singular point (f.p.), on the analytic continuation with respect to the parameter of the singularity (a.f.p.), and on integration by parts (f.p.p.). Formulae of changes of variables in such integrals are presented

Grazing incidence angle based sensing approach integrated with fiber-optic Fourier transform infrared (FO-FTIR) spectroscopy for remote and label-free detection of medical device contaminations

Energy Technology Data Exchange (ETDEWEB)

Hassan, Moinuddin, E-mail: moinuddin.hassan@fda.hhs.gov; Ilev, Ilko [Optical Therapeutics and Medical Nanophotonics Laboratory, Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland 20993 (United States)

2014-10-15

Contamination of medical devices has become a critical and prevalent public health safety concern since medical devices are being increasingly used in clinical practices for diagnostics, therapeutics and medical implants. The development of effective sensing methods for real-time detection of pathogenic contamination is needed to prevent and reduce the spread of infections to patients and the healthcare community. In this study, a hollow-core fiber-optic Fourier transform infrared spectroscopy methodology employing a grazing incidence angle based sensing approach (FO-FTIR-GIA) was developed for detection of various biochemical contaminants on medical device surfaces. We demonstrated the sensitivity of FO-FTIR-GIA sensing approach for non-contact and label-free detection of contaminants such as lipopolysaccharide from various surface materials relevant to medical device. The proposed sensing system can detect at a minimum loading concentration of approximately 0.7 μg/cm{sup 2}. The FO-FTIR-GIA has the potential for the detection of unwanted pathogen in real time.

Family welfare programme calls for an integrated approach.

Science.gov (United States)

Singh, P N

3 phases can be identified in India's family planning program in the 4 decades since the country achieved its independence: a stage designed to improve the infrastructure of family planning; a phase of integration of different health and family welfare services; and an attempt of community involvement and universal coverage. At this time there is a widespread infrastructure and a growing awareness of family planning services. The birthrate has declined from 41.2/1000 in the 1960s to 33.3/1000 in the 1980s; the mortality rate declined from 27.4 to 14.2. The current facilities of family welfare services are inadequate, particularly in rural areas. The present provision of auxiliary nurse midwives (ANMS) at the rate of 1/5000 can cover effectively only 1/3 of eligible couples. Further, in rural areas, communication and motivational efforts are lacking as well as easy availability of personnel and medical supplies. Finally, about 40% of the rural population lives below the poverty line and have not reached the economic threshold which is essential for adoption of the small family norm. The primary issue is to deal with the problem of social development. The emphasis needs to be on an integrated and package approach to economic progress and social transformation coupled with the family planning program. The best way to bring about the needed socioeconomic change is to provide educational and gainful employment opportunities.

The Integration Movement in the Caribbean at Crossroads: Towards a New Approach of Integration

OpenAIRE

Uziel Nogueira

1997-01-01

The Institute for the Integration of Latin America and the Caribbean (INTAL) has inaugurated a Working Papers Series with the publication of a study by Uziel Nogueira, the Institute's Economist. Entitled "The Integration Movement in the Caribbean at the Crossroads: Towards a New Approach to Integration", the study opens with an overview of the movement towards integration among the English-speaking countries of the Caribbean. It continues with an analysis of the integration process during thi...

Recent developments in the path integral approach to anomalies

International Nuclear Information System (INIS)

Fujikawa, Kazuo.

1986-08-01

After a brief summary of the path integral approach to anomalous identities, some of the recent developments in this approach are discussed. The topics discussed include (i) Construction of the effective action by means of the covariant current, (ii) Gauss law constraint in anomalous gauge theories, (iii) Path integral approach to anomalies in superconformal transformations, (iv) Conformal and ghost number anomalies in string theory in analogy with the instanton calculation, (v) Covariant local Lorentz anomaly and its connection with the mathematical construction of the consistent anomaly. (author)

Modelling efficient innovative work: integration of economic and social psychological approaches

Directory of Open Access Journals (Sweden)

Babanova Yulia

2017-01-01

Full Text Available The article deals with the relevance of integration of economic and social psychological approaches to the solution of enhancing the efficiency of innovation management. The content, features and specifics of the modelling methods within each of approaches are unfolded and options of integration are considered. The economic approach lies in the generation of the integrated matrix concept of management of innovative development of an enterprise in line with the stages of innovative work and the use of the integrated vector method for the evaluation of the innovative enterprise development level. The social psychological approach lies in the development of a system of psychodiagnostic indexes of activity resources within the scope of psychological innovative audit of enterprise management and development of modelling methods for the balance of activity trends. Modelling the activity resources is based on the system of equations accounting for the interaction type of psychodiagnostic indexes. Integration of two approaches includes a methodological level, a level of empirical studies and modelling methods. There are suggested options of integrating the economic and psychological approaches to analyze available material and non-material resources of the enterprises’ innovative work and to forecast an optimal option of development based on the implemented modelling methods.

Integrating Adult Learning and Technologies for Effective Education: Strategic Approaches

Science.gov (United States)

Wang, Victor C. X.

2010-01-01

As adult learners and educators pioneer the use of technology in the new century, attention has been focused on developing strategic approaches to effectively integrate adult learning and technology in different learning environments. "Integrating Adult Learning and Technologies for Effective Education: Strategic Approaches" provides innovative…

Systems Engineering for Space Exploration Medical Capabilities

Science.gov (United States)

Mindock, Jennifer; Reilly, Jeffrey; Rubin, David; Urbina, Michelle; Hailey, Melinda; Hanson, Andrea; Burba, Tyler; McGuire, Kerry; Cerro, Jeffrey; Middour, Chris;

Integrating Quality Improvement and Continuing Professional Development at an Academic Medical Center: A Partnership Between Practice Plan, Hospital, and Medical School.

Science.gov (United States)

Gold, Barbara; England, Dawn; Riley, William; Jacobs-Halsey, Ginny; Webb, Corinne; Daniels, Bobbi

2016-01-01

While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts. This article provides a case example describing our organizational context, what was done, and with what effect and makes our example and lessons learned available to others. We developed a new educational QI program that was jointly planned and implemented by a group comprising major QI stakeholders. This project was intended to create horizontal organizational linkages between continuing professional development, clinicians, the hospital, and QI department and produce QI activities that aligned with the strategic objectives of senior management. The group developed and implemented a curriculum based on Lean methodology and concepts from the Institute for Health Care Improvement Model for Improvement. Two cohorts (27 teams) completed the training and planned and implemented QI projects. All projects were aligned with organizational quality, safety, and patient experience goals. The majority of projects met their aim statements. This case description provides an example of successful horizontal integration of an AMCs' QI functions to disseminate knowledge and implement meaningful QI aligned with strategic objectives (vertical integration).

The Intersystem Model of Psychotherapy: An Integrated Systems Treatment Approach

Science.gov (United States)

Weeks, Gerald R.; Cross, Chad L.

2004-01-01

This article introduces the intersystem model of psychotherapy and discusses its utility as a truly integrative and comprehensive approach. The foundation of this conceptually complex approach comes from dialectic metatheory; hence, its derivation requires an understanding of both foundational and integrational constructs. The article provides a…

An approach for access differentiation design in medical distributed applications built on databases.

Science.gov (United States)

Shoukourian, S K; Vasilyan, A M; Avagyan, A A; Shukurian, A K

1999-01-01

A formalized "top to bottom" design approach was described in [1] for distributed applications built on databases, which were considered as a medium between virtual and real user environments for a specific medical application. Merging different components within a unified distributed application posits new essential problems for software. Particularly protection tools, which are sufficient separately, become deficient during the integration due to specific additional links and relationships not considered formerly. E.g., it is impossible to protect a shared object in the virtual operating room using only DBMS protection tools, if the object is stored as a record in DB tables. The solution of the problem should be found only within the more general application framework. Appropriate tools are absent or unavailable. The present paper suggests a detailed outline of a design and testing toolset for access differentiation systems (ADS) in distributed medical applications which use databases. The appropriate formal model as well as tools for its mapping to a DMBS are suggested. Remote users connected via global networks are considered too.

Psychiatry in the Harvard Medical School-Cambridge Integrated Clerkship: an innovative, year-long program.

Science.gov (United States)

Griswold, Todd; Bullock, Christopher; Gaufberg, Elizabeth; Albanese, Mark; Bonilla, Pedro; Dvorak, Ramona; Epelbaum, Claudia; Givon, Lior; Kueppenbender, Karsten; Joseph, Robert; Boyd, J Wesley; Shtasel, Derri

2012-09-01

The authors present what is to their knowledge the first description of a model for longitudinal third-year medical student psychiatry education. A longitudinal, integrated psychiatric curriculum was developed, implemented, and sustained within the Harvard Medical School-Cambridge Integrated Clerkship. Curriculum elements include longitudinal mentoring by attending physicians in an outpatient psychiatry clinic, exposure to the major psychotherapies, psychopharmacology training, acute psychiatry "immersion" experiences, and a variety of clinical and didactic teaching sessions. The longitudinal psychiatry curriculum has been sustained for 8 years to-date, providing effective learning as demonstrated by OSCE scores, NBME shelf exam scores, written work, and observed clinical work. The percentage of students in this clerkship choosing psychiatry as a residency specialty is significantly greater than those in traditional clerkships at Harvard Medical School and greater than the U.S. average. Longitudinal integrated clerkship experiences are effective and sustainable; they offer particular strengths and opportunities for psychiatry education, and may influence student choice of specialty.

Curriculum Integration Using Enterprise Resource Planning: An Integrative Case Approach

Science.gov (United States)

Cannon, David M.; Klein, Helen A; Koste, Lori L.; Magal, Simha R.

2004-01-01

Efforts to achieve greater curriculum integration in schools of business have included team teaching, student group projects, multidisciplinary cases, and, more recently, the use of enterprise resource planning (ERP) systems. Although these approaches are beneficial, they tend to be implemented on an ad hoc basis rather than through curriculum…

The Bioinformatics of Integrative Medical Insights: Proposals for an International Psycho-Social and Cultural Bioinformatics Project

Directory of Open Access Journals (Sweden)

Ernest Rossi

2006-01-01

Full Text Available We propose the formation of an International Psycho-Social and Cultural Bioinformatics Project (IPCBP to explore the research foundations of Integrative Medical Insights (IMI on all levels from the molecular-genomic to the psychological, cultural, social, and spiritual. Just as The Human Genome Project identified the molecular foundations of modern medicine with the new technology of sequencing DNA during the past decade, the IPCBP would extend and integrate this neuroscience knowledge base with the technology of gene expression via DNA/proteomic microarray research and brain imaging in development, stress, healing, rehabilitation, and the psychotherapeutic facilitation of existentional wellness. We anticipate that the IPCBP will require a unique international collaboration of, academic institutions, researchers, and clinical practioners for the creation of a new neuroscience of mind-body communication, brain plasticity, memory, learning, and creative processing during optimal experiential states of art, beauty, and truth. We illustrate this emerging integration of bioinformatics with medicine with a videotape of the classical 4-stage creative process in a neuroscience approach to psychotherapy.

The Bioinformatics of Integrative Medical Insights: Proposals for an International PsychoSocial and Cultural Bioinformatics Project

Directory of Open Access Journals (Sweden)

Ernest Rossi

2006-01-01

Full Text Available We propose the formation of an International PsychoSocial and Cultural Bioinformatics Project (IPCBP to explore the research foundations of Integrative Medical Insights (IMI on all levels from the molecular-genomic to the psychological, cultural, social, and spiritual. Just as The Human Genome Project identified the molecular foundations of modern medicine with the new technology of sequencing DNA during the past decade, the IPCBP would extend and integrate this neuroscience knowledge base with the technology of gene expression via DNA/proteomic microarray research and brain imaging in development, stress, healing, rehabilitation, and the psychotherapeutic facilitation of existentional wellness. We anticipate that the IPCBP will require a unique international collaboration of, academic institutions, researchers, and clinical practioners for the creation of a new neuroscience of mind-body communication, brain plasticity, memory, learning, and creative processing during optimal experiential states of art, beauty, and truth. We illustrate this emerging integration of bioinformatics with medicine with a videotape of the classical 4-stage creative process in a neuroscience approach to psychotherapy.

Evaluation of Chest Ultrasound Integrated Teaching of Respiratory System Physiology to Medical Students

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Paganini, Matteo; Bondì, Michela; Rubini, Alessandro

2017-01-01

Ultrasound imaging is a widely used diagnostic technique, whose integration in medical education is constantly growing. The aim of this study was to evaluate chest ultrasound usefulness in teaching respiratory system physiology, students' perception of chest ultrasound integration into a traditional lecture in human physiology, and short-term…

The Impact of Technology Integration through a Transformative Approach

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Cubillos, Jo Ann

2013-01-01

The integration of technology into classroom instruction in K-12 schools remains problematic. The problems associated with this integration are troubling, as technology integration may change a teacher's pedagogy toward more innovative approaches that increase student achievement. The purpose of this study was to document teachers' experiences as…

Major Approaches to Medical Diagnosis and their Drawbacks

Directory of Open Access Journals (Sweden)

Sabina MUNTEANU

2009-12-01

Full Text Available The ability to reason within a dynamical environment is of a crucial importance in Artificial Intelligence. Medical diagnosis is a dynamic and very complex field which needs special attention Our quest is for a system for medical diagnosis, that could model its search space efficiently and dynamically, while confronted with sequential tests. We present below some of the major approaches from literature, with their drawbacks, and conclude that a combinative hybridization of a certain type would be useful to overcome the failures.

Findings from the Harvard Medical School Cambridge Integrated Clerkship, a Year-Long Longitudinal Psychiatry Experience.

Science.gov (United States)

Cheng, Elisa; Hirsh, David; Gaufberg, Elizabeth; Griswold, Todd; Wesley Boyd, J

2018-06-01

The Harvard Medical School Cambridge Integrated Clerkship is a longitudinal integrated clerkship that has provided an alternative clinical model for medical education in psychiatry since its inception in 2004. This study was undertaken in an effort to better understand the student experience of the Cambridge Integrated Clerkship and how it may have impacted students' perceptions of and interest in psychiatry, as well as performance. Qualitative surveys were sent via e-mail to the first 11 student cohorts who had completed the Cambridge Integrated Clerkship (from 2004 to 2014) and for whom we had e-mail addresses (N = 100), and the free-text responses were coded thematically. All available standardized scoring data and residency match data for Cambridge Integrated Clerkship graduates were obtained. From 2006 to 2014, 12 out of 73 Cambridge Integrated Clerkship students who entered the match chose a psychiatry residency (16.4%), four times more than students in traditional clerkships at Harvard Medical School (3.8% of 1355 students) or the national average (4.1% of 146,066 US applicants). Thirty of the 100 surveyed Cambridge Integrated Clerkship graduates (30%) responded to the qualitative survey with free-text remarks on a number of themes. Cambridge Integrated Clerkship students compared positively to their classmates in terms of standardized test performance. Their fourfold higher match rate into psychiatry compared to other students raises intriguing questions as to what role a longitudinal clerkship might have played in developing interest in psychiatry as a career.

Situating Remediation: Accommodating Success and Failure in Medical Education Systems.

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Ellaway, Rachel H; Chou, Calvin L; Kalet, Adina L

2018-03-01

There has been a widespread shift to competency-based medical education (CBME) in the United States and Canada. Much of the CBME discourse has focused on the successful learner, with relatively little attention paid to what happens in CBME systems when learners stumble or fail. Emerging issues, such as the well-documented problem of "failure to fail" and concerns about litigious learners, have highlighted a need for well-defined and integrated frameworks to support and guide strategic approaches to the remediation of struggling medical learners.This Perspective sets out a conceptual review of current practices and an argument for a holistic approach to remediation in the context of their parent medical education systems. The authors propose parameters for integrating remediation into CBME and describe a model based on five zones of practice along with the rules of engagement associated with each zone. The zones are "normal" curriculum, corrective action, remediation, probation, and exclusion.The authors argue that, by linking and integrating theory and practice in remediation with CBME, a more integrated systems-level response to differing degrees of learner difficulty and failure can be developed. The proposed model demonstrates how educational practice in different zones is based on different rules, roles, responsibilities, and thresholds for moving between zones. A model such as this can help medical educators and medical education leaders take a more integrated approach to learners' failures as well as their successes by being more explicit about the rules of engagement that apply in different circumstances across the competency continuum.

A CMMI-based approach for medical software project life cycle study.

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Chen, Jui-Jen; Su, Wu-Chen; Wang, Pei-Wen; Yen, Hung-Chi

2013-01-01

In terms of medical techniques, Taiwan has gained international recognition in recent years. However, the medical information system industry in Taiwan is still at a developing stage compared with the software industries in other nations. In addition, systematic development processes are indispensable elements of software development. They can help developers increase their productivity and efficiency and also avoid unnecessary risks arising during the development process. Thus, this paper presents an application of Light-Weight Capability Maturity Model Integration (LW-CMMI) to Chang Gung Medical Research Project (CMRP) in the Nuclear medicine field. This application was intended to integrate user requirements, system design and testing of software development processes into three layers (Domain, Concept and Instance) model. Then, expressing in structural System Modeling Language (SysML) diagrams and converts part of the manual effort necessary for project management maintenance into computational effort, for example: (semi-) automatic delivery of traceability management. In this application, it supports establishing artifacts of "requirement specification document", "project execution plan document", "system design document" and "system test document", and can deliver a prototype of lightweight project management tool on the Nuclear Medicine software project. The results of this application can be a reference for other medical institutions in developing medical information systems and support of project management to achieve the aim of patient safety.

Bayesian Analysis for Risk Assessment of Selected Medical Events in Support of the Integrated Medical Model Effort

Science.gov (United States)

Gilkey, Kelly M.; Myers, Jerry G.; McRae, Michael P.; Griffin, Elise A.; Kallrui, Aditya S.

2012-01-01

The Exploration Medical Capability project is creating a catalog of risk assessments using the Integrated Medical Model (IMM). The IMM is a software-based system intended to assist mission planners in preparing for spaceflight missions by helping them to make informed decisions about medical preparations and supplies needed for combating and treating various medical events using Probabilistic Risk Assessment. The objective is to use statistical analyses to inform the IMM decision tool with estimated probabilities of medical events occurring during an exploration mission. Because data regarding astronaut health are limited, Bayesian statistical analysis is used. Bayesian inference combines prior knowledge, such as data from the general U.S. population, the U.S. Submarine Force, or the analog astronaut population located at the NASA Johnson Space Center, with observed data for the medical condition of interest. The posterior results reflect the best evidence for specific medical events occurring in flight. Bayes theorem provides a formal mechanism for combining available observed data with data from similar studies to support the quantification process. The IMM team performed Bayesian updates on the following medical events: angina, appendicitis, atrial fibrillation, atrial flutter, dental abscess, dental caries, dental periodontal disease, gallstone disease, herpes zoster, renal stones, seizure, and stroke.

Integrated systems approach to meet the insider threat

International Nuclear Information System (INIS)

Barnes, L.D.

1985-01-01

This paper describes an approach to mitigating the insider threat by integrating and supplementing existing data systems and procedures without placing an undue burden on plant management and operating personnel. Nuclear facilities have plans to deal with any forseeable chain of events, and long-term records of activities are maintained to verify that the requirements are met. The integrated systems approach proposed in this paper does not change established facility practices; rather, the approach attempts to utilize the information generated by the system. This will provide real-time interaction between the documented work permits, the operating procedure system, and the security system so that controlled access authorizations are based on a need to enter and access is limited to specific times and places

Integrating consumer engagement in health and medical research - an Australian framework.

Science.gov (United States)

Miller, Caroline L; Mott, Kathy; Cousins, Michael; Miller, Stephanie; Johnson, Anne; Lawson, Tony; Wesselingh, Steve

2017-02-10

Quality practice of consumer engagement is still in its infancy in many sectors of medical research. The South Australian Health and Medical Research Institute (SAHMRI) identified, early in its development, the opportunity to integrate evidence-driven consumer and community engagement into its operations. SAHMRI partnered with Health Consumers Alliance and consumers in evidence generation. A Partnership Steering Committee of researchers and consumers was formed for the project. An iterative mixed-method qualitative process was used to generate a framework for consumer engagement. This process included a literature review followed by semi-structured interviews with experts in consumer engagement and lead medical researchers, group discussions and a consensus workshop with the Partnership Steering Committee, facilitated by Health Consumer Alliance. The literature revealed a dearth of evidence about effective consumer engagement methodologies. Four organisational dimensions are reported to contribute to success, namely governance, infrastructure, capacity and advocacy. Key themes identified through the stakeholder interviews included sustained leadership, tangible benefits, engagement strategies should be varied, resourcing, a moral dimension, and challenges. The consensus workshop produced a framework and tangible strategies. Comprehensive examples of consumer participation in health and medical research are limited. There are few documented studies of what techniques are effective. This evidence-driven framework, developed in collaboration with consumers, is being integrated in a health and medical research institute with diverse programs of research. This framework is offered as a contribution to the evidence base around meaningful consumer engagement and as a template for other research institutions to utilise.

Conducting financial due diligence of medical practices.

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Louiselle, P

1995-12-01

Many healthcare organizations are acquiring medical practices in an effort to build more integrated systems of healthcare products and services. This acquisition activity must be approached cautiously to ensure that medical practices being acquired do not have deficiencies that would jeopardize integration efforts. Conducting a thorough due diligence analysis of medical practices before finalizing the transaction can limit the acquiring organizations' legal and financial exposure and is a necessary component to the acquisition process. The author discusses the components of a successful financial due diligence analysis and addresses some of the risk factors in a practice acquisition.

Integrated Medical Model (IMM) Project Verification, Validation, and Credibility (VVandC)

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Walton, M.; Boley, L.; Keenan, L.; Kerstman, E.; Shah, R.; Young, M.; Saile, L.; Garcia, Y.; Meyers, J.; Reyes, D.

2015-01-01

The Integrated Medical Model (IMM) Project supports end user requests by employing the Integrated Medical Evidence Database (iMED) and IMM tools as well as subject matter expertise within the Project. The iMED houses data used by the IMM. The IMM is designed to forecast relative changes for a specified set of crew health and mission success risk metrics by using a probabilistic model based on historical data, cohort data, and subject matter expert opinion. A stochastic approach is taken because deterministic results would not appropriately reflect the uncertainty in the IMM inputs. Once the IMM was conceptualized, a plan was needed to rigorously assess input information, framework and code, and output results of the IMM, and ensure that end user requests and requirements were considered during all stages of model development and implementation, as well as lay the foundation for external review and application. METHODS: In 2008, the Project team developed a comprehensive verification and validation (VV) plan, which specified internal and external review criteria encompassing 1) verification of data and IMM structure to ensure proper implementation of the IMM, 2) several validation techniques to confirm that the simulation capability of the IMM appropriately represents occurrences and consequences of medical conditions during space missions, and 3) credibility processes to develop user confidence in the information derived from the IMM. When the NASA-STD-7009 (7009) [1] was published, the Project team updated their verification, validation, and credibility (VVC) project plan to meet 7009 requirements and include 7009 tools in reporting VVC status of the IMM. Construction of these tools included meeting documentation and evidence requirements sufficient to meet external review success criteria. RESULTS: IMM Project VVC updates are compiled recurrently and include updates to the 7009 Compliance and Credibility matrices. Reporting tools have evolved over the lifetime of

Availability objectives integration to design. The CIDEM approach

International Nuclear Information System (INIS)

Degrave, C.; Martin-Onraet, M.

1994-01-01

Considering the operation experience feedback from its nuclear park and from foreign parks, and considering new approaches and design tools such as concurrent engineering, total quality, etc., EDF (Electricite de France) has decided to start the CIDEM approach (integration of availability, operating experience feedback and maintenance into design), an analytical and systematical study process for new projects (REP2000 (or PWR2000)), in order to optimize as much as possible the design phase while integrating maintenance, availability and safety objectives, with the view of a minimized kWh cost. This process, already used in other industries, employs concepts such as RAM (Reliability Availability Maintainability), RCM (Reliability Centered Maintenance) and ILS (Integrated Logistic Support). The availability and maintenance scheduling studies for the REP2000 project are detailed. 10 fig., 6 tab

Conceptual information processing: A robust approach to KBS-DBMS integration

Science.gov (United States)

Lazzara, Allen V.; Tepfenhart, William; White, Richard C.; Liuzzi, Raymond

1987-01-01

Integrating the respective functionality and architectural features of knowledge base and data base management systems is a topic of considerable interest. Several aspects of this topic and associated issues are addressed. The significance of integration and the problems associated with accomplishing that integration are discussed. The shortcomings of current approaches to integration and the need to fuse the capabilities of both knowledge base and data base management systems motivates the investigation of information processing paradigms. One such paradigm is concept based processing, i.e., processing based on concepts and conceptual relations. An approach to robust knowledge and data base system integration is discussed by addressing progress made in the development of an experimental model for conceptual information processing.

Open architecture design and approach for the Integrated Sensor Architecture (ISA)

Science.gov (United States)

Moulton, Christine L.; Krzywicki, Alan T.; Hepp, Jared J.; Harrell, John; Kogut, Michael

2015-05-01

Integrated Sensor Architecture (ISA) is designed in response to stovepiped integration approaches. The design, based on the principles of Service Oriented Architectures (SOA) and Open Architectures, addresses the problem of integration, and is not designed for specific sensors or systems. The use of SOA and Open Architecture approaches has led to a flexible, extensible architecture. Using these approaches, and supported with common data formats, open protocol specifications, and Department of Defense Architecture Framework (DoDAF) system architecture documents, an integration-focused architecture has been developed. ISA can help move the Department of Defense (DoD) from costly stovepipe solutions to a more cost-effective plug-and-play design to support interoperability.

CANDU plant life management - An integrated approach

International Nuclear Information System (INIS)

Hopkins, J.R.

1998-01-01

An integrated approach to plant life management has been developed for CANDU reactors. Strategies, methods, and procedures have been developed for assessment of critical systems structures and components and for implementing a reliability centred maintenance program. A Technology Watch program is being implemented to eliminate 'surprises'. Specific work has been identified for 1998. AECL is working on the integrated program with CANDU owners and seeks participation from other CANDU owners

Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

Science.gov (United States)

Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

2009-02-01

The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.

The ties that bind: an integrative framework of physician-hospital alignment

Directory of Open Access Journals (Sweden)

Gemmel Paul

2011-02-01

Full Text Available Abstract Background Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Discussion Empirical studies and management theory (agency theory and social exchange theory are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Summary Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

The ties that bind: an integrative framework of physician-hospital alignment.

Science.gov (United States)

Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2011-02-15

Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Empirical studies and management theory (agency theory and social exchange theory) are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

Decoding the integrated approach to yoga therapy: Qualitative evidence based conceptual framework.

Science.gov (United States)

Villacres, Maria Del Carmen; Jagannathan, Aarti; Nagarathna, R; Ramakrsihna, Jayashree

2014-01-01

The aim of this study was to define, decode, and append to the conceptual frame-work of the integrated approach to yoga therapy (IAYT). Four stakeholders who followed two in-patients with depression over a period of 2 weeks in the residential center Arogyadhama (of Swami Vivekananda Yoga Anusandana Samsthana, Bangalore, India) were interviewed before the start of the IAYT treatment and prior to discharge of the patient. The patients were also interviewed pre and post and were observed once during their session. The data from the audio recordings from eight in-depth interviews were transcribed manually and qualitative analysis was conducted. The conceptual frame-work of IAYT depicts that patient related factors ("co-operation of patient", "patients awareness of his/her condition"), therapist related factors ("ability to guide", "the assistance to the patients", "explanation of the exercises") and treatment related factors ("combination of psychiatric or Ayurvedic medication with yoga", "counseling during the IAYT treatment", duration of treatment), play an integrated role in reaching the "aim of IAYT" and experiencing "improvements and changes". The IAYT is a holistic program and the ability of the patient to cooperate with and integrate the available factors (therapist related and treatment related) could enable best results.

Narrative Financial Therapy: Integrating a Financial Planning Approach with Therapeutic Theory

Directory of Open Access Journals (Sweden)

Megan A. McCoy

2014-03-01

Full Text Available The article serves as one of the first attempts to develop an integrated theoretical approach to financial therapy that can be used by practitioners from multiple disciplines. The presented approach integrates the components of the six-step financial planning process with components of empirically-supported therapeutic methods. This integration provides the foundation for a manualized approach to financial therapy, shaped by the writings of narrative theorists and select cognitive-behavioral interventions that can be used both by mental health and financial professionals.

Medical biofilms--nanotechnology approaches.

Science.gov (United States)

Neethirajan, Suresh; Clond, Morgan A; Vogt, Adam

2014-10-01

Biofilms are colonies of bacteria or fungi that adhere to a surface, protected by an extracellular polymer matrix composed of polysaccharides and extracellular DNA. They are highly complex and dynamic multicellular structures that resist traditional means of killing planktonic bacteria. Recent developments in nanotechnology provide novel approaches to preventing and dispersing biofilm infections, which are a leading cause of morbidity and mortality. Medical device infections are responsible for approximately 60% of hospital acquired infections. In the United States, the estimated cost of caring for healthcare-associated infections is approximately between $28 billion and $45 billion per year. In this review, we will discuss our current understanding of biofilm formation and degradation, its relevance to challenges in clinical practice, and new technological developments in nanotechnology that are designed to address these challenges.

Fifteen minute consultation: A structured approach to the management of children and adolescents with medically unstable anorexia nervosa.

Science.gov (United States)

Allison, Elizabeth; Dawson, Nicola; Phillips, Jane; Lynch, Catherine; Coleman, Jacinta

2017-08-01

Assessing and managing children who are underweight is an integral part of paediatric practice. Young people with anorexia nervosa (AN) are mainly cared for in the community by specialist eating disorder services. However, increasing numbers require admission to paediatric wards with medical instability due to the complications of starvation. Despite recommendations published in the junior MARSIPAN report in 2012, many paediatricians still feel poorly equipped to care for these high-risk patients. This article aims to provide a safe and structured approach to the assessment and management of children and adolescents with medically unstable AN. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Integration of computer technology into the medical curriculum: the King's experience

Directory of Open Access Journals (Sweden)

Vickie Aitken

1997-12-01

Full Text Available Recently, there have been major changes in the requirements of medical education which have set the scene for the revision of medical curricula (Towle, 1991; GMC, 1993. As part of the new curriculum at King's, the opportunity has been taken to integrate computer technology into the course through Computer-Assisted Learning (CAL, and to train graduates in core IT skills. Although the use of computers in the medical curriculum has up to now been limited, recent studies have shown encouraging steps forward (see Boelen, 1995. One area where there has been particular interest is the use of notebook computers to allow students increased access to IT facilities (Maulitz et al, 1996.

Benefits and problems in implementation for integrated medical information system

International Nuclear Information System (INIS)

Park, Chang Seo; Kim, Kee Deog; Park, Hyok; Jeong, Ho Gul

2005-01-01

Once the decision has been made to adopt an integrated medical information system (IMIS), there are a number of tissues to overcome. Users need to be aware of the impact the change will make on end users and be prepared to address issues that arise before they become problems. The purpose of this study is to investigate the benefits and unexpected problems encountered in the implementation of IMIS and to determine a useful framework for IMIS. The Yonsei University Dental Hospital is steadily constructing an IMIS. The vendor's PACS software, Piview STAR, supports transactions between workstations that are approved to integrating the health care enterprise (IHE) with security function. It is necessary to develop an excellent framework that is good for the patient, health care provider and information system vendors, in an expert, efficient, and cost-effective manner. The problems encountered with IMIS implementation were high initial investments, delay of EMR enforcement, underdevelopment of digital radiographic appliances and software and insufficient educational training for users. The clinical environments of dental IMIS is some different from the medical situation. The best way to overcome these differences is to establish a gold standard of dental IMIS integration, which estimates the cost payback. The IHE and its technical framework are good for the patient, the health care provider and all information systems vendors.

Learning environment, approaches to learning and learning preferences: medical students versus general education students.

Science.gov (United States)

Ullah, Raza

2016-05-01

The main objective of the study was to see whether medical students use more desirable approaches to studying than general education students. Survey method was used to collect data from both the medical students and the general education students. The survey of the medical students was carried out between January and March, 2012. The survey was administered to all the medical students present in lecture halls on day of data collection, while general education students were randomly selected from four subject areas at two universities. In total, 976 medical students and 912 general students participated in the study. Of the general students, 494(54%) were boys and 418(46%)were girls with an overall mean age of 20.53±1.77 years (range: 17-27 years). The medical students' perceptions of their learning environment and their learning preferences were broadly similar to that of general education students with the exception of workload. The medical students perceived the workload to be less appropriate (Mean = 2.06±0.72) than the students in general education (Mean = 2.84±0.90). The medical students were more likely to use the deep approach to studying (Mean = 3.66±0.59) than the students in general education (Mean = 3.16±0.91). The students in general education were slightly more likely to use the organized studying (Mean = 3.44±0.90) than the medical students (Mean =3.23±0.90). Both medical students and the students in general education tended to use the surface approaches along with other approaches to studying. There was not a great difference between the medical students and the students pursuing general education with regard to perceptions of the learning environment and approaches to learning.

Integrated VCOs for Medical Implant Transceivers

Directory of Open Access Journals (Sweden)

Ahmet Tekin

2008-01-01

Full Text Available The 402–405 MHz medical implant communication service (MICS band has recently been allocated by the US Federal Communication Commission (FCC with the potential to replace the low-frequency inductive coupling techniques in implantable devices. This band was particularly chosen to provide full-integration, low-power, faster data transfer, and longer communication range. This paper investigates the design of a voltage-controlled oscillator (VCO that will be an essential building block of such wireless implantable devices operating in the MICS service band. Three different integrated quadrature VCOs that meet the requirements of the MICS standard are designed in 0.18 μm TSMC CMOS process to propose an optimum choice. Their performances in terms of power consumption, die area, linearity, and phase noise are compared. The fabricated VCOs are a four-stage differential ring VCO, an LC tank VCO directly loaded with a poly-phase filter, and an 800 MHz LC tank VCO with a high-frequency master-slave divider. All three architectures target a VCO gain of Kvco = 15 MHz/V with 3 calibration control and 2 frequency-shift keying (FSK control signals and are designed for 1.5 V supply voltage in a 0.18-μm standard CMOS process.

Designing medical technology for resilience : integrating health economics and human factors approaches

NARCIS (Netherlands)

Borsci, Simone; Uchegbu, Ijeoma; Buckle, Peter; Ni, Zhifang; Walne, Simon; Hanna, George B.

2018-01-01

Introduction: The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of

An integrated approach for integrated intelligent instrumentation and control system (I3CS)

International Nuclear Information System (INIS)

Jung, C.H.; Kim, J.T.; Kwon, K.C.

1997-01-01

Nuclear power plants to guarantee the safety of public should be designed to reduce the operator intervention resulting in operating human errors, identify the process states in transients, and aid to make a decision of their tasks and guide operator actions. For the sake of this purpose, MMIS(MAN-Machine Interface System) in NPPs should be the integrated top-down approach tightly focused on the function-based task analysis including an advanced digital technology, an operator support function, and so on. The advanced I and C research team in KAERI has embarked on developing an Integrated Intelligent Instrumentation and Control System (I 3 CS) for Korea's next generation nuclear power plants. I 3 CS bases the integrated top-down approach on the function-based task analysis, modern digital technology, standardization and simplification, availability and reliability, and protection of investment. (author). 4 refs, 6 figs

Vertical integration in medical school: effect on the transition to postgraduate training.

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Wijnen-Meijer, Marjo; ten Cate, Olle Th J; van der Schaaf, Marieke; Borleffs, Jan C C

2010-03-01

Recently, many medical schools' curricula have been revised so that they represent vertically integrated (VI) curricula. Important changes include: the provision of earlier clinical experience; longer clerkships, and the fostering of increasing levels of responsibility. One of the aims of vertical integration is to facilitate the transition to postgraduate training. The purpose of the present study is to determine whether a VI curriculum at medical school affects the transition to postgraduate training in a positive way. We carried out a questionnaire study among graduates of six medical schools in the Netherlands, who had followed either a VI or a non-VI curriculum. Items in the questionnaire focused on preparedness for work and postgraduate training, the time and number of applications required to be admitted to residency, and the process of making career choices. In comparison with those who have followed non-VI programmes, graduates of VI curricula appear to make definitive career choices earlier, need less time and fewer applications to obtain residency positions and feel more prepared for work and postgraduate training. The curriculum at medical school affects the transition to postgraduate training. Additional research is required to determine which components of the curriculum cause this effect and to specify under which conditions this effect occurs.

Positive Impact of Integrating Histology and Physiology Teaching at a Medical School in China

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Sherer, Renslow; Wan, Yu; Dong, Hongmei; Cooper, Brian; Morgan, Ivy; Peng, Biwen; Liu, Jun; Wang, Lin; Xu, David

2014-01-01

To modernize its stagnant, traditional curriculum and pedagogy, the Medical School of Wuhan University in China adopted (with modifications) the University of Chicago's medical curriculum model. The reform effort in basic sciences was integrating histology and physiology into one course, increasing the two subjects' connection to clinical…

Towards integration of health economics into medical education and clinical practice in Saudi Arabia.

Science.gov (United States)

Da'ar, Omar B; Al Shehri, Ali M

2015-04-01

In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. This article recognizes the dearth of knowledge and application of economic analyses in medical education and clinical practice in Saudi Arabia. In particular, it highlights the desirability of knowledge of health economics in ensuring certain competencies in medical education and the rationale for inviting doctors to apply knowledge of economics in Saudi Arabia. In addition, the article discusses challenges that hinder integrating health economics into clinical practice. Furthermore, the article typifies some of the important economic phenomena that physicians need to discern. Besides, the article provides implications for incorporating economic analysis into medical education and clinical practice in Saudi Arabia. Finally, the article concludes by demonstrating how health economics can enhance doctors' knowledge and recommends the country to move towards integrating health economics into medical education and clinical practice for best practice.

Solving the interoperability challenge of a distributed complex patient guidance system: a data integrator based on HL7's Virtual Medical Record standard.

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Marcos, Carlos; González-Ferrer, Arturo; Peleg, Mor; Cavero, Carlos

2015-05-01

We show how the HL7 Virtual Medical Record (vMR) standard can be used to design and implement a data integrator (DI) component that collects patient information from heterogeneous sources and stores it into a personal health record, from which it can then retrieve data. Our working hypothesis is that the HL7 vMR standard in its release 1 version can properly capture the semantics needed to drive evidence-based clinical decision support systems. To achieve seamless communication between the personal health record and heterogeneous data consumers, we used a three-pronged approach. First, the choice of the HL7 vMR as a message model for all components accompanied by the use of medical vocabularies eases their semantic interoperability. Second, the DI follows a service-oriented approach to provide access to system components. Third, an XML database provides the data layer.Results The DI supports requirements of a guideline-based clinical decision support system implemented in two clinical domains and settings, ensuring reliable and secure access, high performance, and simplicity of integration, while complying with standards for the storage and processing of patient information needed for decision support and analytics. This was tested within the framework of a multinational project (www.mobiguide-project.eu) aimed at developing a ubiquitous patient guidance system (PGS). The vMR model with its extension mechanism is demonstrated to be effective for data integration and communication within a distributed PGS implemented for two clinical domains across different healthcare settings in two nations. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Integration of pharmacists into a patient-centered medical home.

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Scott, Mollie Ashe; Hitch, Bill; Ray, Lisa; Colvin, Gaye

2011-01-01

To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. Family medicine residency training program in North Carolina from 2001 to 2011. Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche

How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

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Omid Asemani

2015-09-01

Full Text Available Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs.

Preregularization and the path integral approach to the chiral anomaly

International Nuclear Information System (INIS)

Elias, V.; McKeon, G.; Steele, T.; Mann, R.B.; Treml, T.F.; Sherry, T.N.

1987-01-01

We explore the connection between perturbative and non-perturbative (path-integral) approaches to the axial anomaly. In particular, we show how the Jacobian associated with the fermionic measure corresponding to local axial transformations may be calculated directly from shift-of-integration-variable surface terms in four Euclidean dimensions. No regularization (explicit parametrization of UV infinities) is required in this approach, but invariance of the Jacobian under vector gauge transformations (i.e. preregularization) is required to remove a variable-of-integration ambiguity within the expression for the Jacobian of the fermionic measure. (orig.)

Integrating Food-Water-Energy Research through a Socio-Ecosystem Approach

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Manuel Maass

2017-08-01

Full Text Available The nexus approach helps in recognizing the link between water, energy, and food production systems, emphasizing the need to manage them in a more integrated way. The socio-ecosystem (SES approach, however, goes beyond that, by incorporating the regulation and supporting services in the management equation. Changes in ecosystem integrity affect the delivery of ecosystem services to society, which affects local people's well-being, creating a feedback mechanism regarding management strategies. The SES approach makes explicit the “human-bio-physical” nature of our interaction with ecosystems, highlighting the need for a more integrated and interconnected social-ecological research perspective. In addition, the SES approach makes more explicit the multi-scale character of the ecological processes that structure and maintain social-ecological systems. Water dynamics have an important role in shaping ecosystem's structure and functioning, as well as determining the systems capacity for delivering provisioning services. The tropical dry-deciduous forest (TDF, is particularly useful in studying water-food-energy trade-off interactions. Recently, a category 5 hurricane landed in the study area (Mexico's Pacific coast, triggering various social and ecological problems. This event is challenging the current forest management strategies in the region. The extreme hydrometeorological event created an excellent opportunity to test and promote the SES approach for more integrated food-water-energy research. By using the SES approach within our long-term socio-ecological research project, it was easier to identify opportunities for tackling trade-offs between maintaining the transformation of the system and a more sustainable alternative: promoting the maintenance of the ecosystem's integrity and its capacity to deliver provisioning and regulating services.

Towards a fully-fledged integration of spiritual care and medical care

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Kruizinga, R.; Scherer-Rath, M.; Schilderman, J. B. A. M.; Puchalski, C. M.; van Laarhoven, H. W. M.

2017-01-01

In this article we aim to set out current problems that hinder a fully-fledged integration of spiritual and medical care that address these obstacles. We discuss the following five statements: 1. Spiritual care requires a clear and inclusive definition of spirituality; 2. Empirical evidence for

Towards a fully-fledged integration of spiritual care and medical care

NARCIS (Netherlands)

Kruizinga, R.; Scherer-Rath, M.; Schilderman, J.B.A.M.; Puchalski, C.; Laarhoven, H.W.M. van

2018-01-01

In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for

Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

Science.gov (United States)

Jones, Judith A; Snyder, John J; Gesko, David S; Helgeson, Michael J

2017-09-01

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

STRATEGIC PROJECT MANAGEMENT PRINCIPLES, PROGRAMS AND PORTFOLIOS OF THE MEDICAL INSTITUTION

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Елена Борисовна ДАНЧЕНКО

2017-03-01

Full Text Available The article gives a brief overview of the latest research in the direction of the use of the project-based approach to the management of medical institutions. It is shown that medicine today is a project-oriented area, and modern scientific studies suggest the use of not only the project management approach and portfolio management. The various scientific sources proposed the classification of projects of medical institutions, mechanisms of formation of projects portfolios of such institutions. The concept of integrated management of medical institutions, which includes strategic, project, portfolio, program management approach (S3P-concept, is offered. According to this concept, the process of S3P-management of the medical institution will include four stages, which are closely interrelated. For the first time, the pair principles of S3P-management are formulated. The proposed concept and principles of S3P-management of medical institution require further development and creating of models, methods and integrated management tools, as well as the development of a system of indicators verify compliance with the organization's strategy of its projects, projects portfolios and programs. This concept and the proposed integrated management principles are universal and can be applied to any project-oriented area.

A Key Event Path Analysis Approach for Integrated Systems

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Jingjing Liao

2012-01-01

Full Text Available By studying the key event paths of probabilistic event structure graphs (PESGs, a key event path analysis approach for integrated system models is proposed. According to translation rules concluded from integrated system architecture descriptions, the corresponding PESGs are constructed from the colored Petri Net (CPN models. Then the definitions of cycle event paths, sequence event paths, and key event paths are given. Whereafter based on the statistic results after the simulation of CPN models, key event paths are found out by the sensitive analysis approach. This approach focuses on the logic structures of CPN models, which is reliable and could be the basis of structured analysis for discrete event systems. An example of radar model is given to characterize the application of this approach, and the results are worthy of trust.

A design approach for integrating thermoelectric devices using topology optimization

DEFF Research Database (Denmark)

Soprani, Stefano; Haertel, Jan Hendrik Klaas; Lazarov, Boyan Stefanov

2016-01-01

Efficient operation of thermoelectric devices strongly relies on the thermal integration into the energy conversion system in which they operate. Effective thermal integration reduces the temperature differences between the thermoelectric module and its thermal reservoirs, allowing the system...... to operate more efficiently. This work proposes and experimentally demonstrates a topology optimization approach as a design tool for efficient integration of thermoelectric modules into systems with specific design constraints. The approach allows thermal layout optimization of thermoelectric systems...... for different operating conditions and objective functions, such as temperature span, efficiency, and power recoveryrate. As a specific application, the integration of a thermoelectric cooler into the electronics section ofa downhole oil well intervention tool is investigated, with the objective of minimizing...

Linking Science and Language Arts: A Review of the Literature Which Compares Integrated versus Non-Integrated Approaches

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Bradbury, Leslie U.

2014-01-01

The purpose of this paper is to review the literature published during the last 20 years that investigates the impact of approaches that describe themselves as integrating science and language arts on student learning and/or attitude at the elementary level. The majority of papers report that integrated approaches led to greater student…

Spatial Data Integration Using Ontology-Based Approach

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Hasani, S.; Sadeghi-Niaraki, A.; Jelokhani-Niaraki, M.

2015-12-01

In today's world, the necessity for spatial data for various organizations is becoming so crucial that many of these organizations have begun to produce spatial data for that purpose. In some circumstances, the need to obtain real time integrated data requires sustainable mechanism to process real-time integration. Case in point, the disater management situations that requires obtaining real time data from various sources of information. One of the problematic challenges in the mentioned situation is the high degree of heterogeneity between different organizations data. To solve this issue, we introduce an ontology-based method to provide sharing and integration capabilities for the existing databases. In addition to resolving semantic heterogeneity, better access to information is also provided by our proposed method. Our approach is consisted of three steps, the first step is identification of the object in a relational database, then the semantic relationships between them are modelled and subsequently, the ontology of each database is created. In a second step, the relative ontology will be inserted into the database and the relationship of each class of ontology will be inserted into the new created column in database tables. Last step is consisted of a platform based on service-oriented architecture, which allows integration of data. This is done by using the concept of ontology mapping. The proposed approach, in addition to being fast and low cost, makes the process of data integration easy and the data remains unchanged and thus takes advantage of the legacy application provided.

SPATIAL DATA INTEGRATION USING ONTOLOGY-BASED APPROACH

Directory of Open Access Journals (Sweden)

S. Hasani

2015-12-01

Full Text Available In today's world, the necessity for spatial data for various organizations is becoming so crucial that many of these organizations have begun to produce spatial data for that purpose. In some circumstances, the need to obtain real time integrated data requires sustainable mechanism to process real-time integration. Case in point, the disater management situations that requires obtaining real time data from various sources of information. One of the problematic challenges in the mentioned situation is the high degree of heterogeneity between different organizations data. To solve this issue, we introduce an ontology-based method to provide sharing and integration capabilities for the existing databases. In addition to resolving semantic heterogeneity, better access to information is also provided by our proposed method. Our approach is consisted of three steps, the first step is identification of the object in a relational database, then the semantic relationships between them are modelled and subsequently, the ontology of each database is created. In a second step, the relative ontology will be inserted into the database and the relationship of each class of ontology will be inserted into the new created column in database tables. Last step is consisted of a platform based on service-oriented architecture, which allows integration of data. This is done by using the concept of ontology mapping. The proposed approach, in addition to being fast and low cost, makes the process of data integration easy and the data remains unchanged and thus takes advantage of the legacy application provided.

Addressing uncertainties in the ERICA Integrated Approach

International Nuclear Information System (INIS)

Oughton, D.H.; Agueero, A.; Avila, R.; Brown, J.E.; Copplestone, D.; Gilek, M.

2008-01-01

Like any complex environmental problem, ecological risk assessment of the impacts of ionising radiation is confounded by uncertainty. At all stages, from problem formulation through to risk characterisation, the assessment is dependent on models, scenarios, assumptions and extrapolations. These include technical uncertainties related to the data used, conceptual uncertainties associated with models and scenarios, as well as social uncertainties such as economic impacts, the interpretation of legislation, and the acceptability of the assessment results to stakeholders. The ERICA Integrated Approach has been developed to allow an assessment of the risks of ionising radiation, and includes a number of methods that are intended to make the uncertainties and assumptions inherent in the assessment more transparent to users and stakeholders. Throughout its development, ERICA has recommended that assessors deal openly with the deeper dimensions of uncertainty and acknowledge that uncertainty is intrinsic to complex systems. Since the tool is based on a tiered approach, the approaches to dealing with uncertainty vary between the tiers, ranging from a simple, but highly conservative screening to a full probabilistic risk assessment including sensitivity analysis. This paper gives on overview of types of uncertainty that are manifest in ecological risk assessment and the ERICA Integrated Approach to dealing with some of these uncertainties

Implementation of a phased medical educational approach in a developing country

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Michelle Holm

2015-11-01

Full Text Available Objective: Healthcare provider education can serve as one method for improving healthcare in developing countries. Working with providers at St Luke Hospital in Haiti, we developed a phased educational approach through partnership development, face-to-face teaching, and virtual educational tools. Design: Our novel approach included three phases: direct patient care, targeted education, and utilization of the train-the-trainer model. Our end goal was an educational system that could be utilized by the local medical staff to continually improve their medical knowledge, even after our educational project was completed. We implemented pre- and post-lecture evaluations during our teaching phase to determine whether the education provided was effective and beneficial. Additionally, we provided medical lectures on a shared file internet platform, Box.com, during the train-the-trainer phase to allow healthcare providers in Haiti to access the educational content electronically. Results: In total, 47 lectures were given to 150 medical providers, including nurses, physicians, and pharmacists. Pre- and post-lecture evaluations were administered. The mean was 30.63 (14.40 for pre-lecture evaluations and 93.36 (9.80 for post-lecture evaluations indicating improvement out of a total of 100 possible points. Our collaborative Box.com account contains 214 medical education lectures available for viewing as a constant resource to St Luke Hospital staff. Thus far, 20 of the 43 (47% Haitian medical providers have viewed lectures, with an average of 5.6 lectures viewed per person. Qualitative data suggest that these methods improved communication between healthcare staff, promoted better ways of triaging patients, and improved job satisfaction. Conclusions: A phased educational approach can improve healthcare workers’ knowledge through partnership in a developing country. Educating local providers is one way of ensuring that in-country healthcare staff will

Introduction to solid mechanics an integrated approach

CERN Document Server

Lubliner, Jacob

2017-01-01

This expanded second edition presents in one text the concepts and processes covered in statics and mechanics of materials curricula following a systematic, topically integrated approach. Building on the novel pedagogy of fusing concepts covered in traditional undergraduate courses in rigid-body statics and deformable body mechanics, rather than simply grafting them together, this new edition develops further the authors’ very original treatment of solid mechanics with additional figures, an elaboration on selected solved problems, and additional text as well as a new subsection on viscoelasticity in response to students’ feedback. Introduction to Solid Mechanics: An Integrated Approach, Second Edition, offers a holistic treatment of the depth and breadth of solid mechanics and the inter-relationships of its underlying concepts. Proceeding from first principles to applications, the book stands as a whole greater than the sum of its parts.  .

Using Contemporary Leadership Skills in Medication Safety Programs.

Science.gov (United States)

Hertig, John B; Hultgren, Kyle E; Weber, Robert J

2016-04-01

The discipline of studying medication errors and implementing medication safety programs in hospitals dates to the 1970s. These initial programs to prevent errors focused only on pharmacy operation changes - and not the broad medication use system. In the late 1990s, research showed that faulty systems, and not faulty people, are responsible for errors and require a multidisciplinary approach. The 2013 ASHP Statement on the Role of the Medication Safety Leader recommended that medication safety leaders be integrated team members rather than a single point of contact. Successful medication safety programs must employ a new approach - one that embraces the skills of all health care team members and positions many leaders to improve safety. This approach requires a new set of leadership skills based on contemporary management principles, including followership, team-building, tracking and assessing progress, storytelling and communication, and cultivating innovation, all of which promote transformational change. The application of these skills in developing or changing a medication safety program is reviewed in this article.

Integrated Artificial Intelligence Approaches for Disease Diagnostics.

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Vashistha, Rajat; Chhabra, Deepak; Shukla, Pratyoosh

2018-06-01

Mechanocomputational techniques in conjunction with artificial intelligence (AI) are revolutionizing the interpretations of the crucial information from the medical data and converting it into optimized and organized information for diagnostics. It is possible due to valuable perfection in artificial intelligence, computer aided diagnostics, virtual assistant, robotic surgery, augmented reality and genome editing (based on AI) technologies. Such techniques are serving as the products for diagnosing emerging microbial or non microbial diseases. This article represents a combinatory approach of using such approaches and providing therapeutic solutions towards utilizing these techniques in disease diagnostics.

Learning styles and approaches to learning among medical undergraduates and postgraduates.

Science.gov (United States)

Samarakoon, Lasitha; Fernando, Tharanga; Rodrigo, Chaturaka

2013-03-25

The challenge of imparting a large amount of knowledge within a limited time period in a way it is retained, remembered and effectively interpreted by a student is considerable. This has resulted in crucial changes in the field of medical education, with a shift from didactic teacher centered and subject based teaching to the use of interactive, problem based, student centered learning. This study tested the hypothesis that learning styles (visual, auditory, read/write and kinesthetic) and approaches to learning (deep, strategic and superficial) differ among first and final year undergraduate medical students, and postgraduates medical trainees. We used self administered VARK and ASSIST questionnaires to assess the differences in learning styles and approaches to learning among medical undergraduates of the University of Colombo and postgraduate trainees of the Postgraduate Institute of Medicine, Colombo. A total of 147 participated: 73 (49.7%) first year students, 40 (27.2%) final year students and 34(23.1%) postgraduate students. The majority (69.9%) of first year students had multimodal learning styles. Among final year students, the majority (67.5%) had multimodal learning styles, and among postgraduates, the majority were unimodal (52.9%) learners.Among all three groups, the predominant approach to learning was strategic. Postgraduates had significant higher mean scores for deep and strategic approaches than first years or final years (p learning approaches suggest a positive shift towards deep and strategic learning in postgraduate students. However a similar difference was not observed in undergraduate students from first year to final year, suggesting that their curriculum may not have influenced learning methodology over a five year period.

Criminal Rehabilitation Through Medical Intervention: Moral Liability and the Right to Bodily Integrity.

Science.gov (United States)

Douglas, Thomas

2014-06-01

Criminal offenders are sometimes required, by the institutions of criminal justice, to undergo medical interventions intended to promote rehabilitation. Ethical debate regarding this practice has largely proceeded on the assumption that medical interventions may only permissibly be administered to criminal offenders with their consent. In this article I challenge this assumption by suggesting that committing a crime might render one morally liable to certain forms of medical intervention. I then consider whether it is possible to respond persuasively to this challenge by invoking the right to bodily integrity. I argue that it is not.

The integrated approach methodology for operator information evaluation

International Nuclear Information System (INIS)

Stroube, K.; Modarres, M.; Roush, M.; Hunt, N.; Pearce, R.

1986-01-01

The Integrated Approach has developed a complete method for evaluating the relative importance of operation information improvements. By use of decision trees the impact of information on success probability of a function or system can be evaluated. This approach couples goal trees and human success likelihoods to estimate anticipated consequences of a given information system

Integrated Approach to User Account Management

Science.gov (United States)

Kesselman, Glenn; Smith, William

2007-01-01

IT environments consist of both Windows and other platforms. Providing user account management for this model has become increasingly diffi cult. If Microsoft#s Active Directory could be enhanced to extend a W indows identity for authentication services for Unix, Linux, Java and Macintosh systems, then an integrated approach to user account manag ement could be realized.

Developing and implementing core competencies for integrative medicine fellowships.

Science.gov (United States)

Ring, Melinda; Brodsky, Marc; Low Dog, Tieraona; Sierpina, Victor; Bailey, Michelle; Locke, Amy; Kogan, Mikhail; Rindfleisch, James A; Saper, Robert

2014-03-01

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force's process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.

Integrative medical therapy: examination of meditation's therapeutic and global medicinal outcomes via nitric oxide (review).

Science.gov (United States)

Stefano, George B; Esch, Tobias

2005-10-01

Relaxation techniques are part of the integrative medicine movement that is of growing importance for mainstream medicine. Complementary medical therapies have the potential to affect many physiological systems. Repeatedly studies show the benefits of the placebo response and relaxation techniques in the treatment of hypertension, cardiac arrhythmias, chronic pain, insomnia, anxiety and mild and moderate depression, premenstrual syndrome, and infertility. In itself, relaxation is characterized by a decreased metabolism, heart rate, blood pressure, and rate of breathing as well as an increase in skin temperature. Relaxation approaches, such as progressive muscle relaxation, autogenic training, meditation and biofeedback, are effective in lowering systolic and diastolic blood pressure in hypertensive patients by a significant margin. Given this association with changes in vascular tone, we have hypothesized that nitric oxide, a demonstrated vasodilator substance, contribute to physiological activity of relaxation approaches. We examined the scientific literature concerning the disorders noted earlier for their nitric oxide involvement in an attempt to provide a molecular rationale for the positive effects of relaxation approaches, which are physiological and cognitive process. We conclude that constitutive nitric oxide may crucially contribute to potentially beneficial outcomes and effects in diverse pathologies, exerting a global healing effect.

Workplace mental health: developing an integrated intervention approach

Science.gov (United States)

2014-01-01

Background Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations. Discussion To realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work–related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy. Summary An integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace. PMID:24884425

Cybersecurity and the Medical Device Product Development Lifecycle.

Science.gov (United States)

Jones, Richard W; Katzis, Konstantinos

2017-01-01

Protecting connected medical devices from evolving cyber related threats, requires a continuous lifecycle approach whereby cybersecurity is integrated within the product development lifecycle and both complements and re-enforces the safety risk management processes therein. This contribution reviews the guidance relating to medical device cybersecurity within the product development lifecycle.

Vertical integration in medical school : effect on the transition to postgraduate training

NARCIS (Netherlands)

Wijnen-Meijer, Marjo; ten Cate, Olle Th J.; van der Schaaf, Marieke; Borleffs, Jan C. C.

Objectives Recently, many medical schools' curricula have been revised so that they represent vertically integrated (VI) curricula. Important changes include: the provision of earlier clinical experience; longer clerkships, and the fostering of increasing levels of responsibility. One of the aims of

Integrating semantic dimension into openEHR archetypes for the management of cerebral palsy electronic medical records.

Science.gov (United States)

Ellouze, Afef Samet; Bouaziz, Rafik; Ghorbel, Hanen

2016-10-01

Integrating semantic dimension into clinical archetypes is necessary once modeling medical records. First, it enables semantic interoperability and, it offers applying semantic activities on clinical data and provides a higher design quality of Electronic Medical Record (EMR) systems. However, to obtain these advantages, designers need to use archetypes that cover semantic features of clinical concepts involved in their specific applications. In fact, most of archetypes filed within open repositories are expressed in the Archetype Definition Language (ALD) which allows defining only the syntactic structure of clinical concepts weakening semantic activities on the EMR content in the semantic web environment. This paper focuses on the modeling of an EMR prototype for infants affected by Cerebral Palsy (CP), using the dual model approach and integrating semantic web technologies. Such a modeling provides a better delivery of quality of care and ensures semantic interoperability between all involved therapies' information systems. First, data to be documented are identified and collected from the involved therapies. Subsequently, data are analyzed and arranged into archetypes expressed in accordance of ADL. During this step, open archetype repositories are explored, in order to find the suitable archetypes. Then, ADL archetypes are transformed into archetypes expressed in OWL-DL (Ontology Web Language - Description Language). Finally, we construct an ontological source related to these archetypes enabling hence their annotation to facilitate data extraction and providing possibility to exercise semantic activities on such archetypes. Semantic dimension integration into EMR modeled in accordance to the archetype approach. The feasibility of our solution is shown through the development of a prototype, baptized "CP-SMS", which ensures semantic exploitation of CP EMR. This prototype provides the following features: (i) creation of CP EMR instances and their checking by

Neurocognition, insight and medication nonadherence in schizophrenia: a structural equation modeling approach.

Directory of Open Access Journals (Sweden)

Laurent Boyer

Full Text Available OBJECTIVE: The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia. METHODS: DESIGN: Cross-sectional study. INCLUSION CRITERIA: Diagnosis of schizophrenia according to the DSM-IV-TR criteria. DATA COLLECTION: Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional 'Scale to assess Unawareness of Mental Disorder;' and nonadherence was measured using the multidimensional 'Medication Adherence Rating Scale.' ANALYSIS: Structural equation modeling (SEM was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, 'awareness of positive symptoms' and 'negative symptoms', 'awareness of mental disorder' and nonadherence. RESULTS: One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed χ(2 = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1 neurocognition and 'awareness of symptoms,' (2 'awareness of symptoms' and 'awareness of mental disorder' and (3 'awareness of mental disorder' and nonadherence, mainly in the 'attitude toward taking medication' dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and 'awareness of mental disorder,' and 'awareness of symptoms' and nonadherence. CONCLUSIONS: Our findings support the hypothesis that neurocognition influences 'awareness of symptoms,' which must be integrated into a higher level of insight (i.e., the 'awareness of mental disorder' to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.

Malaysia implements the integrated approach.

Science.gov (United States)

1977-01-01

Malaysia has implemented an integrated approach in providing family planning services to eligible couples. In 1964 the government of Malaysia adopted a national family planning program, and implementation began in the urban areas and extended into the rural areas. Other agencies are involved in providing family planning services and information including the Federation of Family Planning Associations, the Ministry of Health, the National Family Planning Board, and the Federal Land Development Authority. The number of women practicing contraception has increased from 20,726 in 1967 to 533,646 by 1976. and other methods, 3.9%, respectively. There has been an increase in the percentage of acceptors between ages 15-29 from 56% in 1968 to 71.3% in 1975. The 2nd Malaysian national plan will use a multidisciplinary approach to the problem.

Exploring EFL Learners' Perceptions of Integrated Skills Approach: A Grounded Theory

Science.gov (United States)

Tajzad, Maryam; Ostovar-Namaghi, Seyyed Ali

2014-01-01

This qualitative study aims at exploring EFL learners' perceptions of the integrated skills approach to language teaching. To this end, the researchers presented the integrated skills approach to a group of 30 participants and interviewed those who were willing to share their views and experience with the researchers. The researchers used grounded…

Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model.

Science.gov (United States)

De Leeuw, R A; Westerman, Michiel; Nelson, E; Ket, J C F; Scheele, F

2016-07-08

E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.

Science of Integrated Approaches to Natural Resources Management

Science.gov (United States)

Tengberg, Anna; Valencia, Sandra

2017-04-01

To meet multiple environmental objectives, integrated programming is becoming increasingly important for the Global Environmental Facility (GEF), the financial mechanism of the multilateral environmental agreements, including the United Nations Convention to Combat Desertification (UNCCD). Integration of multiple environmental, social and economic objectives also contributes to the achievement of the Sustainable Development Goals (SDGs) in a timely and cost-effective way. However, integration is often not well defined. This paper therefore focuses on identifying key aspects of integration and assessing their implementation in natural resources management (NRM) projects. To that end, we draw on systems thinking literature, and carry out an analysis of a random sample of GEF integrated projects and in-depth case studies demonstrating lessons learned and good practices in addressing land degradation and other NRM challenges. We identify numerous challenges and opportunities of integrated approaches that need to be addressed in order to maximise the catalytic impact of the GEF during problem diagnosis, project design, implementation and governance. We highlight the need for projects to identify clearer system boundaries and main feedback mechanisms within those boundaries, in order to effectively address drivers of environmental change. We propose a theory of change for Integrated Natural Resources Management (INRM) projects, where short-term environmental and socio-economic benefits will first accrue at the local level. Implementation of improved INRM technologies and practices at the local level can be extended through spatial planning, strengthening of innovation systems, and financing and incentive mechanisms at the watershed and/or landscape/seascape level to sustain and enhance ecosystem services at larger scales and longer time spans. We conclude that the evolving scientific understanding of factors influencing social, technical and institutional innovations and

Medical technology integration: CT, angiography, imaging-capable OR-table, navigation and robotics in a multifunctional sterile suite.

Science.gov (United States)

Jacob, A L; Regazzoni, P; Bilecen, D; Rasmus, M; Huegli, R W; Messmer, P

2007-01-01

Technology integration is an enabling technological prerequisite to achieve a major breakthrough in sophisticated intra-operative imaging, navigation and robotics in minimally invasive and/or emergency diagnosis and therapy. Without a high degree of integration and reliability comparable to that achieved in the aircraft industry image guidance in its different facets will not ultimately succeed. As of today technology integration in the field of image-guidance is close to nonexistent. Technology integration requires inter-departmental integration of human and financial resources and of medical processes in a dialectic way. This expanded techno-socio-economic integration has profound consequences for the administration and working conditions in hospitals. At the university hospital of Basel, Switzerland, a multimodality multifunction sterile suite was put into operation after a substantial pre-run. We report the lessons learned during our venture into the world of medical technology integration and describe new possibilities for similar integration projects in the future.

SESSION V: INTEGRATED APPROACHES IN LAND AND WATER ...

African Journals Online (AJOL)

SESSION V: INTEGRATED APPROACHES IN LAND AND WATER MANAGEMENT RESEARCH/LAND AND WATER MANAGEMENT ECONOMICS AND POLICY - Socioeconomic implications of improved forage species on smallholder farms in Kenya.

[Research and development of medical case database: a novel medical case information system integrating with biospecimen management].

Science.gov (United States)

Pan, Shiyang; Mu, Yuan; Wang, Hong; Wang, Tong; Huang, Peijun; Ma, Jianfeng; Jiang, Li; Zhang, Jie; Gu, Bing; Yi, Lujiang

2010-04-01

To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.

Ares I Integrated Test Approach

Science.gov (United States)

Taylor, Jim

2008-01-01

This slide presentation reviews the testing approach that NASA is developing for the Ares I launch vehicle. NASA is planning a complete series of development, qualification and verification tests. These include: (1) Upper stage engine sea-level and altitude testing (2) First stage development and qualification motors (3) Upper stage structural and thermal development and qualification test articles (4) Main Propulsion Test Article (MPTA) (5) Upper stage green run testing (6) Integrated Vehicle Ground Vibration Testing (IVGVT) and (7) Aerodynamic characterization testing.

An integrated approach for integrated intelligent instrumentation and control system (I{sup 3}CS)

Energy Technology Data Exchange (ETDEWEB)

Jung, C H; Kim, J T; Kwon, K C [Korea Atomic Energy Research Inst., Yusong, Taejon (Korea, Republic of)

1997-07-01

Nuclear power plants to guarantee the safety of public should be designed to reduce the operator intervention resulting in operating human errors, identify the process states in transients, and aid to make a decision of their tasks and guide operator actions. For the sake of this purpose, MMIS(MAN-Machine Interface System) in NPPs should be the integrated top-down approach tightly focused on the function-based task analysis including an advanced digital technology, an operator support function, and so on. The advanced I and C research team in KAERI has embarked on developing an Integrated Intelligent Instrumentation and Control System (I{sup 3}CS) for Korea`s next generation nuclear power plants. I{sup 3}CS bases the integrated top-down approach on the function-based task analysis, modern digital technology, standardization and simplification, availability and reliability, and protection of investment. (author). 4 refs, 6 figs.

Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: a comprehensive approach.

Science.gov (United States)

Birkhead, Guthrie S; Klein, Susan J; Candelas, Alma R; O'Connell, Daniel A; Rothman, Jeffrey R; Feldman, Ira S; Tsui, Dennis S; Cotroneo, Richard A; Flanigan, Colleen A

2007-10-01

New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration. HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development. IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain. A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.

Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

Science.gov (United States)

Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

2014-01-01

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

[Information technology in medical education].

Science.gov (United States)

Ramić, A

1999-01-01

The role of information technology in educational models of under-graduate and post-graduate medical education is growing in 1980's influenced by PC's break-in in medical practice and creating relevant data basis, and, particularly, in 1990's by integration of information technology on international level, development of international network, Internet, Telemedicin, etc. The development of new educational information technology is evident, proving that information in transfer of medical knowledge, medical informatics and communication systems represent the base of medical practice, medical education and research in medical sciences. In relation to the traditional approaches in concept, contents and techniques of medical education, new models of education in training of health professionals, using new information technology, offer a number of benefits, such as: decentralization and access to relevant data sources, collecting and updating of data, multidisciplinary approach in solving problems and effective decision-making, and affirmation of team work within medical and non-medical disciplines. Without regard to the dynamics of change and progressive reform orientation within health sector, the development of modern medical education is inevitable for all systems a in which information technology and available data basis, as a base of effective and scientifically based medical education of health care providers, give guarantees for efficient health care and improvement of health of population.

Interfaces and Integration of Medical Image Analysis Frameworks: Challenges and Opportunities.

Science.gov (United States)

Covington, Kelsie; McCreedy, Evan S; Chen, Min; Carass, Aaron; Aucoin, Nicole; Landman, Bennett A

2010-05-25

Clinical research with medical imaging typically involves large-scale data analysis with interdependent software toolsets tied together in a processing workflow. Numerous, complementary platforms are available, but these are not readily compatible in terms of workflows or data formats. Both image scientists and clinical investigators could benefit from using the framework which is a most natural fit to the specific problem at hand, but pragmatic choices often dictate that a compromise platform is used for collaboration. Manual merging of platforms through carefully tuned scripts has been effective, but exceptionally time consuming and is not feasible for large-scale integration efforts. Hence, the benefits of innovation are constrained by platform dependence. Removing this constraint via integration of algorithms from one framework into another is the focus of this work. We propose and demonstrate a light-weight interface system to expose parameters across platforms and provide seamless integration. In this initial effort, we focus on four platforms Medical Image Analysis and Visualization (MIPAV), Java Image Science Toolkit (JIST), command line tools, and 3D Slicer. We explore three case studies: (1) providing a system for MIPAV to expose internal algorithms and utilize these algorithms within JIST, (2) exposing JIST modules through self-documenting command line interface for inclusion in scripting environments, and (3) detecting and using JIST modules in 3D Slicer. We review the challenges and opportunities for light-weight software integration both within development language (e.g., Java in MIPAV and JIST) and across languages (e.g., C/C++ in 3D Slicer and shell in command line tools).

Integrated assessment of the global warming problem: A decision-analytical approach

International Nuclear Information System (INIS)

Van Lenthe, J.; Hendrickx, L.; Vlek, C.A.J.

1994-12-01

The multi-disciplinary character of the global warming problem asks for an integrated assessment approach for ordering and combining the various physical, ecological, economical, and sociological results. The Netherlands initiated their own National Research Program (NRP) on Global Air Pollution and Climate Change (NRP). The first phase (NRP-1) identified the integration theme as one of five central research themes. The second phase (NRP-2) shows a growing concern for integrated assessment issues. The current two-year research project 'Characterizing the risks: a comparative analysis of the risks of global warming and of relevant policy options, which started in September 1993, comes under the integrated assessment part of the Dutch NRP. The first part of the interim report describes the search for an integrated assessment methodology. It starts with emphasizing the need for integrated assessment at a relatively high level of aggregation and from a policy point of view. The conclusion will be that a decision-analytical approach might fit the purpose of a policy-oriented integrated modeling of the global warming problem. The discussion proceeds with an account on decision analysis and its explicit incorporation and analysis of uncertainty. Then influence diagrams, a relatively recent development in decision analysis, are introduced as a useful decision-analytical approach for integrated assessment. Finally, a software environment for creating and analyzing complex influence diagram models is discussed. The second part of the interim report provides a first, provisional integrated modeling of the global warming problem, emphasizing on the illustration of the decision-analytical approach. Major problem elements are identified and an initial problem structure is developed. The problem structure is described in terms of hierarchical influence diagrams. At some places the qualitative structure is filled with quantitative data

On the functional integral approach in quantum statistics. 1. Some approximations

International Nuclear Information System (INIS)

Dai Xianxi.

1990-08-01

In this paper the susceptibility of a Kondo system in a fairly wide temperature region is calculated in the first harmonic approximation in a functional integral approach. The comparison with that of the renormalization group theory shows that in this region the two results agree quite well. The expansion of the partition function with infinite independent harmonics for the Anderson model is studied. Some symmetry relations are generalized. It is a challenging problem to develop a functional integral approach including diagram analysis, mixed mode effects and some exact relations in the Anderson system proved in the functional integral approach. These topics will be discussed in the next paper. (author). 22 refs, 1 fig

Nurses' clinical reasoning practices that support safe medication administration: An integrative review of the literature.

Science.gov (United States)

Rohde, Emily; Domm, Elizabeth

2018-02-01

To review the current literature about nurses' clinical reasoning practices that support safe medication administration. The literature about medication administration frequently focuses on avoiding medication errors. Nurses' clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses' clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Health databases were accessed and systematically searched for research reporting nurses' clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses' use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that

Integrated Approaches to Occupational Health and Safety: A Systematic Review.

Science.gov (United States)

Cooklin, A; Joss, N; Husser, E; Oldenburg, B

2017-09-01

The study objective was to conduct a systematic review of the effectiveness of integrated workplace interventions that combine health promotion with occupational health and safety. Electronic databases (n = 8), including PsychInfo and MEDLINE, were systematically searched. Studies included were those that reported on workplace interventions that met the consensus definition of an "integrated approach," published in English, in the scientific literature since 1990. Data extracted were occupation, worksite, country, sample size, intervention targets, follow-up period, and results reported. Quality was assessed according to American College of Occupational and Environmental Medicine Practice Guidelines. Heterogeneity precluded formal meta-analyses. Results were classified according to the outcome(s) assessed into five categories (health promotion, injury prevention, occupational health and safety management, psychosocial, and return-on-investment). Narrative synthesis of outcomes was performed. A total of 31 eligible studies were identified; 23 (74%) were (quasi-)experimental trials. Effective interventions were most of those aimed at improving employee physical or mental health. Less consistent results were reported from integrated interventions targeting occupational health and safety management, injury prevention, or organizational cost savings. Integrated approaches have been posed as comprehensive solutions to complex issues. Empirical evidence, while still emerging, provides some support for this. Continuing investment in, and evaluation of, integrated approaches are worthwhile.

An integrated lean-methods approach to hospital facilities redesign.

Science.gov (United States)

Nicholas, John

2012-01-01

Lean production methods for eliminating waste and improving processes in manufacturing are now being applied in healthcare. As the author shows, the methods are appropriate for redesigning hospital facilities. When used in an integrated manner and employing teams of mostly clinicians, the methods produce facility designs that are custom-fit to patient needs and caregiver work processes, and reduce operational costs. The author reviews lean methods and an approach for integrating them in the redesign of hospital facilities. A case example of the redesign of an emergency department shows the feasibility and benefits of the approach.

Medical imaging in clinical applications algorithmic and computer-based approaches

CERN Document Server

Bhateja, Vikrant; Hassanien, Aboul

2016-01-01

This volume comprises of 21 selected chapters, including two overview chapters devoted to abdominal imaging in clinical applications supported computer aided diagnosis approaches as well as different techniques for solving the pectoral muscle extraction problem in the preprocessing part of the CAD systems for detecting breast cancer in its early stage using digital mammograms. The aim of this book is to stimulate further research in medical imaging applications based algorithmic and computer based approaches and utilize them in real-world clinical applications. The book is divided into four parts, Part-I: Clinical Applications of Medical Imaging, Part-II: Classification and clustering, Part-III: Computer Aided Diagnosis (CAD) Tools and Case Studies and Part-IV: Bio-inspiring based Computer Aided diagnosis techniques. .

Rationale for an integrated approach to genetic epidemiology.

Science.gov (United States)

Laberge, Claude M; Knoppers, Bartha Maria

1992-10-01

Genetic knowledge is now in the public domain and its interpretation by the media and the citizens brings the issues into the public forum of discussion for the necessary ethical, legal and socio-cultural evaluation of its application. Science is being perceived by some as dangerous and as requiring international regulation. Others feel that genetic knowledge will be the breakthrough that will permit medical progress and individual autonomy with regards to personal health and lifestyle choices. The mapping of the human genome has already yielded valuable information on an increasing number of diseases and their variants. Prevailing popular and journalistic archetypes ("imaginaires") used in the media are perceived by the producers as slowing down the possible application of genetic knowledge. The answers to these dilemmas are not readily apparent nor are they prescribed by classical philosophy of medicine. Since genetic knowledge eventually resides with the individual who carries the genes of disease and/or susceptibility, a logical approach to integration of this knowledge at a societal level would seem to reside with individual education and decision-making. The politics of the ensuing social debate could transform the current social contract since an individual's interests need to be balanced against those of his or her immediate family in the sharing of information. The ethical foundations of such a contract requires the genetic education of "Everyone" as a matter of urgent priority. Genetic education should not serve ideological power struggles between the medical establishment and the ethical-legal alliance. Instead, it should ensure the transfer of knowledge to physicians, to patients, to users, to planners, to social science and humanities researchers and to politicians, so that they may make "informed" and free decisions....

Library Collaboration with Medical Humanities in an American Medical College in Qatar

Directory of Open Access Journals (Sweden)

Sally Birch

2013-11-01

Full Text Available The medical humanities, a cross-disciplinary field of practice and research that includes medicine, literature, art, history, philosophy, and sociology, is being increasingly incorporated into medical school curricula internationally. Medical humanities courses in Writing, Literature, Medical Ethics and History can teach physicians-in-training communication skills, doctor-patient relations, and medical ethics, as well as empathy and cross-cultural understanding. In addition to providing educational breadth and variety, the medical humanities can also play a practical role in teaching critical/analytical skills. These skills are utilized in differential diagnosis and problem-based learning, as well as in developing written and oral communications. Communication skills are a required medical competency for passing medical board exams in the U.S., Canada, the UK and elsewhere. The medical library is an integral part of medical humanities training efforts. This contribution provides a case study of the Distributed eLibrary at the Weill Cornell Medical College in Qatar in Doha, and its collaboration with the Writing Program in the Premedical Program to teach and develop the medical humanities. Programs and initiatives of the DeLib library include: developing an information literacy course, course guides for specific courses, the 100 Classic Books Project, collection development of ‘doctors’ stories’ related to the practice of medicine (including medically-oriented movies and TV programs, and workshops to teach the analytical and critical thinking skills that form the basis of humanistic approaches to knowledge. This paper outlines a ‘best practices’ approach to developing the medical humanities in collaboration among the medical library, faculty and administrative stakeholders.

Library collaboration with medical humanities in an american medical college in qatar.

Science.gov (United States)

Birch, Sally; Magid, Amani; Weber, Alan

2013-11-01

The medical humanities, a cross-disciplinary field of practice and research that includes medicine, literature, art, history, philosophy, and sociology, is being increasingly incorporated into medical school curricula internationally. Medical humanities courses in Writing, Literature, Medical Ethics and History can teach physicians-in-training communication skills, doctor-patient relations, and medical ethics, as well as empathy and cross-cultural understanding. In addition to providing educational breadth and variety, the medical humanities can also play a practical role in teaching critical/analytical skills. These skills are utilized in differential diagnosis and problem-based learning, as well as in developing written and oral communications. Communication skills are a required medical competency for passing medical board exams in the U.S., Canada, the UK and elsewhere. The medical library is an integral part of medical humanities training efforts. This contribution provides a case study of the Distributed eLibrary at the Weill Cornell Medical College in Qatar in Doha, and its collaboration with the Writing Program in the Premedical Program to teach and develop the medical humanities. Programs and initiatives of the DeLib library include: developing an information literacy course, course guides for specific courses, the 100 Classic Books Project, collection development of 'doctors' stories' related to the practice of medicine (including medically-oriented movies and TV programs), and workshops to teach the analytical and critical thinking skills that form the basis of humanistic approaches to knowledge. This paper outlines a 'best practices' approach to developing the medical humanities in collaboration among the medical library, faculty and administrative stakeholders.

Consequence Based Design. An approach for integrating computational collaborative models (Integrated Dynamic Models) in the building design phase

DEFF Research Database (Denmark)

Negendahl, Kristoffer

relies on various advancements in the area of integrated dynamic models. It also relies on the application and test of the approach in practice to evaluate the Consequence based design and the use of integrated dynamic models. As a result, the Consequence based design approach has been applied in five...... and define new ways to implement integrated dynamic models for the following project. In parallel, seven different developments of new methods, tools and algorithms have been performed to support the application of the approach. The developments concern: Decision diagrams – to clarify goals and the ability...... affect the design process and collaboration between building designers and simulationists. Within the limits of applying the approach of Consequence based design to five case studies, followed by documentation based on interviews, surveys and project related documentations derived from internal reports...

An interprofessional approach to improving paediatric medication safety

Directory of Open Access Journals (Sweden)

Kennedy Neil

2010-02-01

Full Text Available Abstract Background Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future. Methods An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions. Results Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p Conclusion This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

Science based integrated approach to advanced nuclear fuel development - vision, approach, and overview

Energy Technology Data Exchange (ETDEWEB)

Unal, Cetin [Los Alamos National Laboratory; Pasamehmetoglu, Kemal [IDAHO NATIONAL LAB; Carmack, Jon [IDAHO NATIONAL LAB

2010-01-01

Advancing the performance of Light Water Reactors, Advanced Nuclear Fuel Cycles, and Advanced Rcactors, such as the Next Generation Nuclear Power Plants, requires enhancing our fundamental understanding of fuel and materials behavior under irradiation. The capability to accurately model the nuclear fuel systems is critical. In order to understand specific aspects of the nuclear fuel, fully coupled fuel simulation codes are required to achieve licensing of specific nuclear fuel designs for operation. The backbone of these codes, models, and simulations is a fundamental understanding and predictive capability for simulating the phase and microstructural behavior of the nuclear fuel system materials and matrices. The purpose of this paper is to identify the modeling and simulation approach in order to deliver predictive tools for advanced fuels development. The coordination between experimental nuclear fuel design, development technical experts, and computational fuel modeling and simulation technical experts is a critical aspect of the approach and naturally leads to an integrated, goal-oriented science-based R & D approach and strengthens both the experimental and computational efforts. The Advanced Fuels Campaign (AFC) and Nuclear Energy Advanced Modeling and Simulation (NEAMS) Fuels Integrated Performance and Safety Code (IPSC) are working together to determine experimental data and modeling needs. The primary objective of the NEAMS fuels IPSC project is to deliver a coupled, three-dimensional, predictive computational platform for modeling the fabrication and both normal and abnormal operation of nuclear fuel pins and assemblies, applicable to both existing and future reactor fuel designs. The science based program is pursuing the development of an integrated multi-scale and multi-physics modeling and simulation platform for nuclear fuels. This overview paper discusses the vision, goals and approaches how to develop and implement the new approach.

Science based integrated approach to advanced nuclear fuel development - vision, approach, and overview

International Nuclear Information System (INIS)

Unal, Cetin; Pasamehmetoglu, Kemal; Carmack, Jon

2010-01-01

Advancing the performance of Light Water Reactors, Advanced Nuclear Fuel Cycles, and Advanced Rcactors, such as the Next Generation Nuclear Power Plants, requires enhancing our fundamental understanding of fuel and materials behavior under irradiation. The capability to accurately model the nuclear fuel systems is critical. In order to understand specific aspects of the nuclear fuel, fully coupled fuel simulation codes are required to achieve licensing of specific nuclear fuel designs for operation. The backbone of these codes, models, and simulations is a fundamental understanding and predictive capability for simulating the phase and microstructural behavior of the nuclear fuel system materials and matrices. The purpose of this paper is to identify the modeling and simulation approach in order to deliver predictive tools for advanced fuels development. The coordination between experimental nuclear fuel design, development technical experts, and computational fuel modeling and simulation technical experts is a critical aspect of the approach and naturally leads to an integrated, goal-oriented science-based R and D approach and strengthens both the experimental and computational efforts. The Advanced Fuels Campaign (AFC) and Nuclear Energy Advanced Modeling and Simulation (NEAMS) Fuels Integrated Performance and Safety Code (IPSC) are working together to determine experimental data and modeling needs. The primary objective of the NEAMS fuels IPSC project is to deliver a coupled, three-dimensional, predictive computational platform for modeling the fabrication and both normal and abnormal operation of nuclear fuel pins and assemblies, applicable to both existing and future reactor fuel designs. The science based program is pursuing the development of an integrated multi-scale and multi-physics modeling and simulation platform for nuclear fuels. This overview paper discusses the vision, goals and approaches how to develop and implement the new approach.

Autonomous, In-Flight Crew Health Risk Management for Exploration-Class Missions: Leveraging the Integrated Medical Model for the Exploration Medical System Demonstration Project

Science.gov (United States)

Butler, D. J.; Kerstman, E.; Saile, L.; Myers, J.; Walton, M.; Lopez, V.; McGrath, T.

2011-01-01

The Integrated Medical Model (IMM) captures organizational knowledge across the space medicine, training, operations, engineering, and research domains. IMM uses this knowledge in the context of a mission and crew profile to forecast risks to crew health and mission success. The IMM establishes a quantified, statistical relationship among medical conditions, risk factors, available medical resources, and crew health and mission outcomes. These relationships may provide an appropriate foundation for developing an in-flight medical decision support tool that helps optimize the use of medical resources and assists in overall crew health management by an autonomous crew with extremely limited interactions with ground support personnel and no chance of resupply.

Integrating Theory, Content, and Method to Foster Critical Consciousness in Medical Students: A Comprehensive Model for Cultural Competence Training.

Science.gov (United States)

Dao, Diane K; Goss, Adeline L; Hoekzema, Andrew S; Kelly, Lauren A; Logan, Alexander A; Mehta, Sanjiv D; Sandesara, Utpal N; Munyikwa, Michelle R; DeLisser, Horace M

2017-03-01

Many efforts to design introductory "cultural competence" courses for medical students rely on an information delivery (competence) paradigm, which can exoticize patients while obscuring social context, medical culture, and power structures. Other approaches foster a general open-minded orientation, which can remain nebulous without clear grounding principles. Medical educators are increasingly recognizing the limitations of both approaches and calling for strategies that reenvision cultural competence training. Successfully realizing such alternative strategies requires the development of comprehensive models that specify and integrate theoretical frameworks, content, and teaching principles.In this article, the authors present one such model: Introduction to Medicine and Society (IMS), a required cultural competence course launched in 2013 for first-year medical students at the Perelman School of Medicine at the University of Pennsylvania. Building on critical pedagogy, IMS is centered on a novel specification of "critical consciousness" in clinical practice as an orientation to understanding and pragmatic action in three relational domains: internal, interpersonal, and structural. Instead of transmitting discrete "facts" about patient "types," IMS content provokes students to engage with complex questions bridging the three domains. Learning takes place in a small-group space specifically designed to spur transformation toward critical consciousness. After discussing the three key components of the course design and describing a representative session, the authors discuss the IMS model's implications, reception by students and faculty, and potential for expansion. Their early experience suggests the IMS model successfully engages students and prepares future physicians to critically examine experiences, manage interpersonal dynamics, and structurally contextualize patient encounters.

[Medical science and the human image--on the theory of medical tasks].

Science.gov (United States)

Jenny, S

1993-06-22

Our science-determined medicine interprets the non-individual partial aspects of disease that are approachable by causal analytical thought; therefore, it becomes only then an art of healing when it is complemented by medical craftsmanship and philosophic reflection. Naturopathy perceives the individual as an open self-regulatory system whose innumerable mechanisms and strategies for maintenance of integrity have to be supported. In medical practise both concepts have always to be available concomitantly and and in equal rights, not only for repair of lesions but also for real healing.

Learning about the Weather through an Integrated STEM Approach

Science.gov (United States)

Serin, Gokhan

2014-01-01

Introducing concepts through an integrated science, technology, engineering and mathematics (STEM) approach can promote interest and motivation (Bennett, Lubben and Hogarth, 2007; Bybee, 2010). However, implementing such an approach effectively in a classroom setting, with relevant links, is a challenging task. Some concepts lend themselves more…

Integrated Giant Magnetoresistance Technology for Approachable Weak Biomagnetic Signal Detections.

Science.gov (United States)

Shen, Hui-Min; Hu, Liang; Fu, Xin

2018-01-07

With the extensive applications of biomagnetic signals derived from active biological tissue in both clinical diagnoses and human-computer-interaction, there is an increasing need for approachable weak biomagnetic sensing technology. The inherent merits of giant magnetoresistance (GMR) and its high integration with multiple technologies makes it possible to detect weak biomagnetic signals with micron-sized, non-cooled and low-cost sensors, considering that the magnetic field intensity attenuates rapidly with distance. This paper focuses on the state-of-art in integrated GMR technology for approachable biomagnetic sensing from the perspective of discipline fusion between them. The progress in integrated GMR to overcome the challenges in weak biomagnetic signal detection towards high resolution portable applications is addressed. The various strategies for 1/ f noise reduction and sensitivity enhancement in integrated GMR technology for sub-pT biomagnetic signal recording are discussed. In this paper, we review the developments of integrated GMR technology for in vivo/vitro biomagnetic source imaging and demonstrate how integrated GMR can be utilized for biomagnetic field detection. Since the field sensitivity of integrated GMR technology is being pushed to fT/Hz 0.5 with the focused efforts, it is believed that the potential of integrated GMR technology will make it preferred choice in weak biomagnetic signal detection in the future.

A generic, time-resolved, integrated digital image correlation, identification approach

NARCIS (Netherlands)

Hoefnagels, J.P.M.; Neggers, J.; Blaysat, Benoît; Hild, François; Geers, M.G.D.; Jin, H.; Sciammarella, C.; Yoshida, S.; Lamberti, L.

2015-01-01

A generic one-step Integrated Digital Image Correlation (I-DIC) inverse parameter identification approach is introduced that enables direct identification of constitutive model parameters by intimately integrating a Finite Elements Method (FEM) with Digital Image Correlation (DIC), directly

[Medical tourism and travel - an interdisciplinary approach].

Science.gov (United States)

Freyer, W; Kim, B-S

2014-01-01

Medical tourism (or medical travel, international patient service, cross-border or global health care) is a new current phenomenon with increasing relevance for the two disciplines of medicine and tourism. Both sides hope to improve their reputation and image, as well as to increase their revenues and rate of employment; furthermore, they want to provide better care and service for patients and tourists: Medical tourism can close the gap of the health care system at home, providing better quality, quicker access and cheaper procedures abroad, also with treatments, not - legally - available in the sending country. For the tourism sector it broadens the variety of tourism products and supply of the host country and combines medical treatments and recovery with an attractive stay in a tourism destination for patients and their companions. But in spite of all popularity of this new type of tourism and treatment, there is quite a lack of theory and academic analysis. This article outlines the status quo of scientific research both from a medical and tourism point of view. This interdisciplinary method of approach is based mainly on a state-of-the art review of the current literature. There is a great need for more scientific research in the field of medical tourism, based on the common knowledge of both disciplines tourism and medicine. First there is neither an internationally agreed definition nor a common methodology for data collection. So the real impact of touristic and medical services both for the source and for the receiving countries is un-known and imprecise. Second the internal processes of the health system have to be adapted to the needs of international patients, e. g., medical fee schedule, billing, language, inter-cultural qualifications of the staff. Moreover the whole service chain has to be taken into account, especially the pre- and post-processes, which mostly start or end abroad. Here quality standards as well as accreditations are current

A Integracao de Ensino das Ciencias da Saude (An Integrated Medical Education Program [in Brazil]).

Science.gov (United States)

Pourchet-Campos, M. A.; Guimaraes Junior, Paulino

At the Sixth Annual Reunion of the Brazilian Association of Medical Schools (VI Reuniao Anual da Associacao Brasileira de Escolas Medicas) leaders in the Brazilian medical profession proposed an integrated educational program for training students in the fields of medicine and public health. Under Brazil's present system of education, all…

Ranking the strategies for Indian medical tourism sector through the integration of SWOT analysis and TOPSIS method.

Science.gov (United States)

Ajmera, Puneeta

2017-10-09

Purpose Organizations have to evaluate their internal and external environments in this highly competitive world. Strengths, weaknesses, opportunities and threats (SWOT) analysis is a very useful technique which analyzes the strengths, weaknesses, opportunities and threats of an organization for taking strategic decisions and it also provides a foundation for the formulation of strategies. But the drawback of SWOT analysis is that it does not quantify the importance of individual factors affecting the organization and the individual factors are described in brief without weighing them. Because of this reason, SWOT analysis can be integrated with any multiple attribute decision-making (MADM) technique like the technique for order preference by similarity to ideal solution (TOPSIS), analytical hierarchy process, etc., to evaluate the best alternative among the available strategic alternatives. The paper aims to discuss these issues. Design/methodology/approach In this study, SWOT analysis is integrated with a multicriteria decision-making technique called TOPSIS to rank different strategies for Indian medical tourism in order of priority. Findings SO strategy (providing best facilitation and care to the medical tourists at par to developed countries) is the best strategy which matches with the four elements of S, W, O and T of SWOT matrix and 35 strategic indicators. Practical implications This paper proposes a solution based on a combined SWOT analysis and TOPSIS approach to help the organizations to evaluate and select strategies. Originality/value Creating a new technology or administering a new strategy always has some degree of resistance by employees. To minimize resistance, the author has used TOPSIS as it involves group thinking, requiring every manager of the organization to analyze and evaluate different alternatives and average measure of each parameter in final decision matrix.

Developing a complex systems perspective for medical education to facilitate the integration of basic science and clinical medicine.

Science.gov (United States)

Aron, David C

2017-04-01

The purpose of medical education is to produce competent and capable professional practitioners who can combine the art and science of medicine. Moreover, this process must prepare individuals to practise in a field in which knowledge is increasing and the contexts in which that knowledge is applied are changing in unpredictable ways. The 'basic sciences' are important in the training of a physician. The goal of basic science training is to learn it in a way that the material can be applied in practice. Much effort has been expended to integrate basic science and clinical training, while adding many other topics to the medical curriculum. This effort has been challenging. The aims of the paper are (1) to propose a unifying conceptual framework that facilitates knowledge integration among all levels of living systems from cell to society and (2) illustrate the organizing principles with two examples of the framework in action - cybernetic systems (with feedback) and distributed robustness. Literature related to hierarchical and holarchical frameworks was reviewed. An organizing framework derived from living systems theory and spanning the range from molecular biology to health systems management was developed. The application of cybernetic systems to three levels (regulation of pancreatic beta cell production of insulin, physician adjustment of medication for glycaemic control and development and action of performance measures for diabetes care) was illustrated. Similarly distributed robustness was illustrated by the DNA damage response system and principles underlying patient safety. Each of the illustrated organizing principles offers a means to facilitate the weaving of basic science and clinical medicine throughout the course of study. The use of such an approach may promote systems thinking, which is a core competency for effective and capable medical practice. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

A Triangular Approach to Integrate Research, Education and Practice in Higher Engineering Education

Science.gov (United States)

Heikkinen, Eetu-Pekka; Jaako, Juha; Hiltunen, Jukka

2017-01-01

Separate approaches in engineering education, research and practice are not very useful when preparing students for working life; instead, integration of education, research and industrial practices is needed. A triangular approach (TA) as a method to accomplish this integration and as a method to provide students with integrated expertise is…

A participatory and integrative approach to improve productivity and ergonomics in assembly

NARCIS (Netherlands)

Looze, M.P. de; Rhijn, J.W. van; Deursen, J. van; Tuinzaad, G.H.; Reijneveld, C.N.

2003-01-01

A participatory and integrative approach was applied to improve the productivity and ergonomics of the assembly lines in two factories, producing magnetic stop valves and office furniture, respectively. Main elements of the approach are the active participation of the company and the integration of

The Site Approach - Lessons Learned from the Integrated Safeguards Approach for JNC-1

International Nuclear Information System (INIS)

Kikuchi, M.; Iso, S.; Tomine, K.; Hirato, Y.; Namekawa, M.; Takasugi, N.; Watanabe, M.; Tsutaki, Y.; Asano, T.; Nagatani, T.; Ninagawa, J.; Fujiwara, S.; Takahashi, S.; Kimura, T.; Kodani, Y.; Fukuhara, J.; Miyaji, N.; Kawakami, Y.; Koizumi, A.; Yamazaki, Y.; Nishinosono, S.; Sasaki, K.

2010-01-01

Integrated safeguards approaches for specific sites are recognized important elements in the design of a State-level approach under the concept of grouping facilities. Japan and the IAEA agreed further improvement of integrated safeguards implementation in effective and efficient manner, particularly at large complex nuclear sites in Japan. Japan and the IAEA developed the integrated safeguards approach for specific sites defined at Article 18 of Additional Protocol. In 2008, the IAEA started the three-year test implementation of JNC-1 site approach for improving the effectiveness and efficiency of the safeguards implementation of UDU material handling facilities. Japan and IAEA agreed to adopt the sector concept in order to make clear of subjected nuclear material to be verified. The sector is defined as spatial assignment that treats the same material stratum beyond MBAs in the site. The arrangement of MBAs and related material balance calculations as well as statistical analysis is maintained as a fundamental safeguards measure. At the boundaries of each sector, appropriate unattended NDA system and/or C/S system are installed, and material flows across the boundaries are verified by the system or attendance of resident inspectors. For inventory verification of the nuclear material stayed in sectors, an appropriate numbers of randomly scheduled inspections will be implemented. IAEA can access to the randomly selected sectors within 2 hours after notification. NRTA based on frequent operator's declaration will be performed for achievement of timeliness detection goal. The JNC-1 site approach has been implemented under the enhanced co-operation between the IAEA and SSAC through joint use of equipment and arrangements for DA analysis. Especially, national inspectors are working with IAEA together for coordination with operators. Because NMCC lab analyses all DA samples taken from facilities and the analysis results will be shared by the IAEA, certain numbers of DA

Computational Diagnostic: A Novel Approach to View Medical Data.

Energy Technology Data Exchange (ETDEWEB)

Mane, K. K. (Ketan Kirtiraj); Börner, K. (Katy)

2007-01-01

A transition from traditional paper-based medical records to electronic health record is largely underway. The use of electronic records offers tremendous potential to personalize patient diagnosis and treatment. In this paper, we discuss a computational diagnostic tool that uses digital medical records to help doctors gain better insight about a patient's medical condition. The paper details different interactive features of the tool which offer potential to practice evidence-based medicine and advance patient diagnosis practices. The healthcare industry is a constantly evolving domain. Research from this domain is often translated into better understanding of different medical conditions. This new knowledge often contributes towards improved diagnosis and treatment solutions for patients. But the healthcare industry lags behind to seek immediate benefits of the new knowledge as it still adheres to the traditional paper-based approach to keep track of medical records. However recently we notice a drive that promotes a transition towards electronic health record (EHR). An EHR stores patient medical records in digital format and offers potential to replace the paper health records. Earlier attempts of an EHR replicated the paper layout on the screen, representation of medical history of a patient in a graphical time-series format, interactive visualization with 2D/3D generated images from an imaging device. But an EHR can be much more than just an 'electronic view' of the paper record or a collection of images from an imaging device. In this paper, we present an EHR called 'Computational Diagnostic Tool', that provides a novel computational approach to look at patient medical data. The developed EHR system is knowledge driven and acts as clinical decision support tool. The EHR tool provides two visual views of the medical data. Dynamic interaction with data is supported to help doctors practice evidence-based decisions and make judicious

Joint development of evidence-based medical record by doctors and patients through integrated Chinese and Western medicine on digestive system diseases.

Science.gov (United States)

Li, Bo; Gao, Hong-yang; Gao, Rui; Zhao, Ying-pan; Li, Qing-na; Zhao, Yang; Tang, Xu-dong; Shang, Hong-cai

2016-02-01

Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system. A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases, i.e. PubMed, Excerpt Medica Database, China Biology Medicine disc and China National Knowledge Infrastructure. However, no relevant study on the subjects of interest was identified. Therefore, drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine, we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial. Further, we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders. Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research. The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.

The Next Generation Precision Medical Record - A Framework for Integrating Genomes and Wearable Sensors with Medical Records

OpenAIRE

Batra, Prag; Singh, Enakshi; Bog, Anja; Wright, Mark; Ashley, Euan; Waggott, Daryl

2016-01-01

Current medical records are rigid with regards to emerging big biomedical data. Examples of poorly integrated big data that already exist in clinical practice include whole genome sequencing and wearable sensors for real time monitoring. Genome sequencing enables conventional diagnostic interrogation and forms the fundamental baseline for precision health throughout a patients lifetime. Mobile sensors enable tailored monitoring regimes for both reducing risk through precision health intervent...

Bridging the Gap: A Framework and Strategies for Integrating the Quality and Safety Mission of Teaching Hospitals and Graduate Medical Education.

Science.gov (United States)

Tess, Anjala; Vidyarthi, Arpana; Yang, Julius; Myers, Jennifer S

2015-09-01

Integrating the quality and safety mission of teaching hospitals and graduate medical education (GME) is a necessary step to provide the next generation of physicians with the knowledge, skills, and attitudes they need to participate in health system improvement. Although many teaching hospital and health system leaders have made substantial efforts to improve the quality of patient care, few have fully included residents and fellows, who deliver a large portion of that care, in their efforts. Despite expectations related to the engagement of these trainees in health care quality improvement and patient safety outlined by the Accreditation Council for Graduate Medical Education in the Clinical Learning Environment Review program, a structure for approaching this integration has not been described.In this article, the authors present a framework that they hope will assist teaching hospitals in integrating residents and fellows into their quality and safety efforts and in fostering a positive clinical learning environment for education and patient care. The authors define the six essential elements of this framework-organizational culture, teaching hospital-GME alignment, infrastructure, curricular resources, faculty development, and interprofessional collaboration. They then describe the organizational characteristics required for each element and offer concrete strategies to achieve integration. This framework is meant to be a starting point for the development of robust national models of infrastructure, alignment, and collaboration between GME and health care quality and safety leaders at teaching hospitals.

A manufacturable process integration approach for graphene devices

Science.gov (United States)

Vaziri, Sam; Lupina, Grzegorz; Paussa, Alan; Smith, Anderson D.; Henkel, Christoph; Lippert, Gunther; Dabrowski, Jarek; Mehr, Wolfgang; Östling, Mikael; Lemme, Max C.

2013-06-01

In this work, we propose an integration approach for double gate graphene field effect transistors. The approach includes a number of process steps that are key for future integration of graphene in microelectronics: bottom gates with ultra-thin (2 nm) high-quality thermally grown SiO2 dielectrics, shallow trench isolation between devices and atomic layer deposited Al2O3 top gate dielectrics. The complete process flow is demonstrated with fully functional GFET transistors and can be extended to wafer scale processing. We assess, through simulation, the effects of the quantum capacitance and band bending in the silicon substrate on the effective electric fields in the top and bottom gate oxide. The proposed process technology is suitable for other graphene-based devices such as graphene-based hot electron transistors and photodetectors.

Does the Consecutive Interpreting Approach enhance medical English communication skills of Japanese-speaking students?

Science.gov (United States)

Iizuka, Hideki; Lefor, Alan K

2018-04-19

To determine if the Consecutive Interpreting Approach enhances medical English communication skills of students in a Japanese medical university and to assess this method based on performance and student evaluations.  This is a three-phase study using a mixed-methods design, which starts with four language reproduction activities for 30 medical and 95 nursing students, followed by a quantitative analysis of perfect-match reproduction rates to assess changes over the duration of the study and qualitative error analysis of participants' language reproduction. The final stage included a scored course evaluation and free-form comments to evaluate this approach and to identify effective educational strategies to enhance medical English communication skills. Mean perfect-match reproduction rates of all participants over four reproduction activities differed statistically significantly (repeated measures ANOVA, pEnglish communication skills are enhanced using this approach. Participants expressed positive feedback regarding this instruction method. This approach may be effective to enhance the language skills of non-native English-speaking students seeking to practice medicine in English speaking countries.

A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.

Science.gov (United States)

Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul

2014-01-01

With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context.

A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.

Directory of Open Access Journals (Sweden)

Caricia Catalani

Full Text Available With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1 understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2 develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3 implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context.

Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract

Directory of Open Access Journals (Sweden)

H. Hildebrandt

2010-06-01

Full Text Available Introduction: Integrated care solutions need supportive financial incentives. In this paper we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal.Description of integrated care case: Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH in coope­ration with the physicians' network in the region (MQNK, a German health care management company with a background in medical sociology and health economics (OptiMedis AG and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg.Discussion and (preliminary conclusion: The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a sub­stantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in  morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether - and to what extent - cost reduction may be attributed to a real population health gain.

Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract

Directory of Open Access Journals (Sweden)

H. Hildebrandt

2010-06-01

Full Text Available Introduction: Integrated care solutions need supportive financial incentives. In this paper we describe the financial architecture and operative details of the integrated pilot 'Gesundes Kinzigtal'. Description of integrated care case: Located in Southwest Germany, 'Gesundes Kinzigtal' is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH in coope­ration with the physicians' network in the region (MQNK, a German health care management company with a background in medical sociology and health economics (OptiMedis AG and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg. Discussion and (preliminary conclusion: The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a sub­stantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organisation of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in  morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether - and to what extent - cost reduction may be attributed to a real population health gain.

Should nurses be leaders of integrated health care?

Science.gov (United States)

Thomas, Paul; While, Alison

2007-09-01

To examine the role of nurses within integrated health care. Healthcare planners are overly concerned with the treatment of diseases and insufficiently focused on social cohesion vertical rather than horizontal integration of healthcare effort. These domains need to be better connected, to avoid medicalization of social problems and socialisation of medical problems. Published literature, related to theories of whole system integration. *When conceptualizing whole system integration it helps to consider research insights to be snapshots of more complex stories-in-evolution, and change to be the result of ongoing community dance where multiple players adapt their steps to each other. *One image that helps to conceptualize integration is that of a railway network. Railway tracks and multiple journeys are equally needed; each requiring a different approach for success. *Traditional nursing values make nurses more attuned to the issues of combined vertical and horizontal integration than medical colleagues. Nurses should lead integration at the interface between horizontal and vertical activities. Nursing managers and universities should support the development of nurses as leaders of whole system integration, in partnership with local healthcare organizations.

Conducting Integrated Objective Structured Clinical Examination: Experiences at KIST Medical College, Nepal

Directory of Open Access Journals (Sweden)

Rano Mal Piryani

2013-01-01

Full Text Available Background: Objective structured clinical examination (OSCE, an important tool for assessment of clinical skills, introduced more than 4 decades ago. KIST Medical College, a new medical school of Nepal, affiliated to Tribhuvan University Institute of Medicine, has made learning of physical examination skills structured and integrated with greater involvement of different clinical science departments. Students learn physical examination skills in second year MBBS as a part of early clinical exposure. Objective: To share the experiences regarding implementation of integrated OSCE. Materials and Methods: At the end of clinical posting of learning of physical examination skills, assessment was done with OSCE. Fifteen OSCE stations including each of 5 minutes were developed and arranged. Standardized patients and validated checklist were used. OSCE was conducted in novel way. Prior to the OSCE session: Suitable venue was selected, assessors were identified, standardized patients were selected, running order of the stations in circuit was developed, list of equipments/instruments required was prepared, and tasks, checklists, feedback questionnaires were printed. The day before the OSCE session: OSCE stations were inspected and clearly labeled, condition of required equipments/instruments was checked, a pack of the documents for each OSCE station were made available, and signs were displayed at proper places. On the day of the OSCE session: Reliable stop watch and loud manual bell were used, support staffs were placed to direct the candidates, examiners, and standardized patients (SPs, assessors explained SPs, students were briefed, supervisors observed the session, and feedback were taken from students, assessors, and SPs. At the end of the OSCE session: Checklists and feedback questionnaires were collected, token money was paid to SPs, and a contribution of everyone was appreciated. After the OSCE session: Score was compiled and result declared, and

Twelve tips for integrating leadership development into undergraduate medical education.

Science.gov (United States)

Till, Alex; McKimm, Judy; Swanwick, Tim

2017-10-26

Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership. Drawing from the existing evidence base, the authors' expertise and the latest "thought leadership", these 12 tips provide practical guidance to universities and associated provider organizations, and to academic and clinical faculty, on how to integrate leadership development into their undergraduate medical programs. These 12 tips will help educators provide medical education that incorporates leadership as a core part of a professional's identity, and help students gain a deeper understanding of themselves and the teams, organizations and system they work within.

Medical Approach to the Management of Traumatized Refugees.

Science.gov (United States)

Kinzie, J David

2016-03-01

Refugees are a highly traumatized and culturally diverse group of patients who present many clinical challenges. Refugees have a high prevalence of traumas from torture, ethnic cleansing, and the effects of long civil wars. The most common diagnoses associated with the effects of such traumas are posttraumatic stress disorder (PTSD) or PTSD with comorbid depression; however, psychosis and neurocognitive disorders are also common. For those with PTSD, a suggested treatment approach is long-term supportive psychotherapy with drug treatment directed at reducing the most disruptive symptoms, such as insomnia, nightmares, and irritability or psychosis. The author recommends a sedative tricyclic antidepressant, clonidine or prazosin, and aripiprazole as a useful combination of medications to provide rapid relief. In addition to PTSD, long-term studies indicate a high prevalence of diabetes and hypertension in traumatized refugees. It is therefore important to perform a thorough evaluation for these disorders that includes the measurement of blood pressure and a blood test for diabetes. When managed with such a medical approach, refugees are generally accepting of psychiatric treatment and can obtain relief from the symptoms associated with the massive trauma and losses they have experienced.

Integrating traditional nursing service orientation content with electronic medical record orientation.

Science.gov (United States)

Harton, Brenda B; Borrelli, Larry; Knupp, Ann; Rogers, Necolen; West, Vickie R

2009-01-01

Traditional nursing service orientation classes at an acute care hospital were integrated with orientation to the electronic medical record to blend the two components in a user-friendly format so that the learner is introduced to the culture, processes, and documentation methods of the organization, with an opportunity to document online in a practice domain while lecture and discussion information is fresh.

Intergovernmental approach of the new liberalism in the development of integration processes

Directory of Open Access Journals (Sweden)

O. P. Stadnyk

2013-12-01

Full Text Available Investigated intergovernmental theory approach to understanding the new liberalism integration processes. Determined the nature of the liberal intergovernmental approach that Andrew Moravchik developed within the new liberalism. Emphasized that the intergovernmental approach of the new liberalism theory considers national preferences in international relations as being primarily determined by domestic political processes. Liberal intergovernmental approach rejects the rhetoric of so­called national interests and instead focuses on interest groups that define a specific government policy regarding foreign partners. Specified on crucial economic lobbying pressure defined interest groups in the formation of national preferences. The features considering interest groups that determine foreign policy under the intergovernmental approach a theory of new liberalism. Singled out a number of critical approaches to the liberal intergovernmental approach given the nature explanation integration processes. Clarified the value of the intergovernmental approach within theories of political integration by taking into account the theoretical and conceptual foundations of his liberal variety ­ liberal intergovernmental approach as part of a new theory of liberalism, which involves the formation of national preferences in international relations through domestic contexts interaction of national interest groups and their lobbying pressure.

A Comparative Study on Sugeno Integral Approach to Aggregation of Experts' Opinion

International Nuclear Information System (INIS)

Kim, Seong Ho; Kim, Kil Yoo; Kim, Tae Woon

2007-01-01

A multicriteria decision-making (MCDM) problem of preference ranking of various alternatives is common in science and engineering fields. Usually, the MCDM problem is characterized in terms of two factors: relative importance of each evaluation criterion and appropriateness of each alternative. The ranking is determined by a relative degree of appropriateness of decision alternatives. In reality, there are different grades of interaction among decision criteria. One of well-known approaches to aggregation of those two factors is the weighted arithmetic mean (WAM) approach. Here, importance weights for criteria are viewed as probability measures. The weights are linearly aggregated with appropriateness values. In the present work, the main objective is to study an aggregation model with various grades of interactions among the decision elements. The successful applications of fuzzy integral aggregation operators to subjective MCDM problems have been motivating this work. On the basis of λ-fuzzy measures and Sugeno integral (SI), the SI aggregation approach is proposed. Here, interaction among criteria is dealt with λ-fuzzy measures. Aggregation of these measures and appropriateness values is implemented, especially, by the Sugeno integral as one of fuzzy integrals. Aggregated values obtained by the SI approach are viewed as decision maker's pessimistic (or conservative) attitude towards information aggregation, compared to the WAM approach. Firstly, the concepts of the λ-fuzzy measure and the Sugeno fuzzy integral are introduced. Then, as an application of the SI approach, an illustrative example is given

Attitudes among students and teachers on vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum.

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Brynhildsen, J; Dahle, L O; Behrbohm Fallsberg, M; Rundquist, I; Hammar, M

2002-05-01

Important elements in the curriculum at the Faculty of Health Sciences in Linköping are vertical integration, i.e. integration between the clinical and basic science sections of the curriculum, and horizontal integration between different subject areas. Integration throughout the whole curriculum is time-consuming for both teachers and students and hard work is required for planning, organization and execution. The aim was to assess the importance of vertical and horizontal integration in an undergraduate medical curriculum, according to opinions among students and teachers. In a questionnaire 102 faculty teachers and 106 students were asked about the importance of 14 different components of the undergraduate medical curriculum including vertical and horizontal integration. They were asked to assign between one and six points to each component (6 points = extremely important for the quality of the curriculum; 1 point = unimportant). Students as well as teachers appreciated highly both forms of integration. Students scored horizontal integration slightly but significantly higher than the teachers (median 6 vs 5 points; p=0.009, Mann-Whitney U-test), whereas teachers scored vertical integration higher than students (6 vs 5; p=0.019, Mann-Whitney U-test). Both students and teachers considered horizontal and vertical integration to be highly important components of the undergraduate medical programme. We believe both kinds of integration support problem-based learning and stimulate deep and lifelong learning and suggest that integration should always be considered deeply when a new curriculum is planned for undergraduate medical education.

Integrating the teaching role into one’s identity : A qualitative study of beginning undergraduate medical teachers

NARCIS (Netherlands)

van Lankveld, T.; Schoonenboom, J.; Kusurkar, R.A.; Volman, M.; Beishuizen, J.; Croiset, G.

Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A

Integrating care for individuals with FASD: results from a multi-stakeholder symposium.

Science.gov (United States)

Masotti, Paul; Longstaffe, Sally; Gammon, Holly; Isbister, Jill; Maxwell, Breann; Hanlon-Dearman, Ana

2015-10-05

Fetal Alcohol Spectrum Disorder (FASD) has a significant impact on communities and systems such as health, education, justice and social services. FASD is a complex neurodevelopmental disorder that results in permanent disabilities and associated service needs that change across affected individuals' lifespans. There is a degree of interdependency among medical and non-medical providers across these systems that do not frequently meet or plan a coordinated continuum of care. Improving overall care integration will increase provider-specific and system capacity, satisfaction, quality of life and outcomes. We conducted a consensus generating symposium comprised of 60 experts from different stakeholder groups: Allied & Mental Health, Education, First Nations & Métis Health, Advocates, Primary Care, Government Health Policy, Regional FASD Coordinators, Social Services, and Youth Justice. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Solutions and consensus on prioritized lists were generated by combining the Electronic Meeting System approach with a modified 'Nominal Group Technique'. FASD capacity (e.g., training, education, awareness) needs to be increased in both medical and non-medical providers. Outcomes and integration will be improved by implementing: multidisciplinary primary care group practice models, FASD system navigators/advocates, and patient centred medical homes. Electronic medical records that are accessible to multiple medical and non-medical providers are a key tool to enhancing integration and quality. Eligibility criteria for services are a main barrier to integration across systems. There is a need for culturally and community-specific approaches for First Nations communities. There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and

Positioning oneself within an epistemology: refining our thinking about integrative approaches.

Science.gov (United States)

Dickerson, Victoria C

2010-09-01

Integrative approaches seem to be paramount in the current climate of family therapy and other psychotherapies. However, integration between and among theories and practices can only occur within a specific epistemology. This article makes a distinction between three different epistemologies: individualizing, systems, and poststructural. It then makes the argument that one can integrate theories within epistemologies and one can adopt practices and some theoretical concepts across theories and across epistemologies, but that it is impossible to integrate theories across epistemologies. It further states that although social constructionism has influenced much of contemporary psychological thinking, because of the divergence between a structural and a poststructural approach, constructionism looks different depending upon one's epistemological stance. Examples of integration within epistemologies and of what looks like integration across epistemologies (but is not) further illustrate these important distinctions. The conclusions reached here are crucial to our philosophical considerations, our pedagogical assumptions, and implications for both research and a reflexive clinical practice. 2010 © FPI, Inc.

Evaluating the validity of an integrity-based situational judgement test for medical school admissions.

Science.gov (United States)

Husbands, Adrian; Rodgerson, Mark J; Dowell, Jon; Patterson, Fiona

2015-09-02

While the construct of integrity has emerged as a front-runner amongst the desirable attributes to select for in medical school admissions, it is less clear how best to assess this characteristic. A potential solution lies in the use of Situational Judgement Tests (SJTs) which have gained popularity due to robust psychometric evidence and potential for large-scale administration. This study aims to explore the psychometric properties of an SJT designed to measure the construct of integrity. Ten SJT scenarios, each with five response stems were developed from critical incident interviews with academic and clinical staff. 200 of 520 (38.5 %) Multiple Mini Interview candidates at Dundee Medical School participated in the study during the 2012-2013 admissions cycle. Participants were asked to rate the appropriateness of each SJT response on a 4-point likert scale as well as complete the HEXACO personality inventory and a face validity questionnaire. Pearson's correlations and descriptive statistics were used to examine the associations between SJT score, HEXACO personality traits, pre-admissions measures namely academic and United Kingdom Clinical Aptitude Test (UKCAT) scores, as well as acceptability. Cronbach's alpha reliability for the SJT was .64. Statistically significant correlations ranging from .16 to .36 (.22 to .53 disattenuated) were observed between SJT score and the honesty-humility (integrity), conscientiousness, extraversion and agreeableness dimensions of the HEXACO inventory. A significant correlation of .32 (.47 disattenuated) was observed between SJT and MMI scores and no significant relationship with the UKCAT. Participant reactions to the SJTs were generally positive. Initial findings are encouraging regarding the psychometric robustness of an integrity-based SJT for medical student selection, with significant associations found between the SJTs, integrity, other desirable personality traits and the MMI. The SJTs showed little or no redundancy with

Implementing an Interdisciplinary Student Centric Approach to Work-Integrated Learning

Science.gov (United States)

Marchioro, Gary; Ryan, Maria M.; Perkins, Tim

2014-01-01

This paper describes the implementation of an innovative approach to work-integrated learning using interdisciplinary projects within a university Faculty of Business. Further, it discusses the implementation of integrated and authentic assessments involving academic units in the marketing, urban planning and business communication disciplines.…

An Integrated Neuroscience and Engineering Approach to Classifying Human Brain-States

Science.gov (United States)

2015-12-22

AFRL-AFOSR-VA-TR-2016-0037 An Integrated Neuroscience and Engineering Approach to Classifying Human Brain-States Adrian Lee UNIVERSITY OF WASHINGTON...to 14-09-2015 4. TITLE AND SUBTITLE An Integrated Neuroscience and Engineering Approach to Classifying Human Brain- States 5a.  CONTRACT NUMBER 5b...specific cognitive states remains elusive, owing perhaps to limited crosstalk between the fields of neuroscience and engineering. Here, we report a

Influence of a veterinary curriculum on the approaches and study skills of veterinary medical students.

Science.gov (United States)

Chigerwe, Munashe; Ilkiw, Jan E; Boudreaux, Karen A

2011-01-01

The objectives of the present study were to evaluate first-, second-, third-, and fourth-year veterinary medical students' approaches to studying and learning as well as the factors within the curriculum that may influence these approaches. A questionnaire consisting of the short version of the Approaches and Study Skills Inventory for Students (ASSIST) was completed by 405 students, and it included questions relating to conceptions about learning, approaches to studying, and preferences for different types of courses and teaching. Descriptive statistics, factor analysis, Cronbach's alpha analysis, and log-linear analysis were performed on the data. Deep, strategic, and surface learning approaches emerged. There were a few differences between our findings and those presented in previous studies in terms of the correlation of the subscale monitoring effectiveness, which showed loading with both the deep and strategic learning approaches. In addition, the subscale alertness to assessment demands showed correlation with the surface learning approach. The perception of high workloads, the use of previous test files as a method for studying, and examinations that are based only on material provided in lecture notes were positively associated with the surface learning approach. Focusing on improving specific teaching and assessment methods that enhance deep learning is anticipated to enhance students' positive learning experience. These teaching methods include instructors who encourage students to be critical thinkers, the integration of course material in other disciplines, courses that encourage thinking and reading about the learning material, and books and articles that challenge students while providing explanations beyond lecture material.

Project INTEGRATE - a common methodological approach to understand integrated health care in Europe

Directory of Open Access Journals (Sweden)

Lucinda Cash-Gibson

2014-12-01

Full Text Available Background: The use of case studies in health services research has proven to be an excellent methodology for gaining in-depth understanding of the organisation and delivery of health care. This is particularly relevant when looking at the complexity of integrated healthcare programmes, where multifaceted interactions occur at the different levels of care and often without a clear link between the interventions (new and/or existing and their impact on outcomes (in terms of patients health, both patient and professional satisfaction and cost-effectiveness. Still, integrated care is seen as a core strategy in the sustainability of health and care provision in most societies in Europe and beyond. More specifically, at present, there is neither clear evidence on transferable factors of integrated care success nor a method for determining how to establish these specific success factors. The drawback of case methodology in this case, however, is that the in-depth results or lessons generated are usually highly context-specific and thus brings the challenge of transferability of findings to other settings, as different health care systems and different indications are often not comparable. Project INTEGRATE, a European Commission-funded project, has been designed to overcome these problems; it looks into four chronic conditions in different European settings, under a common methodology framework (taking a mixed-methods approach to try to overcome the issue of context specificity and limited transferability. The common methodological framework described in this paper seeks to bring together the different case study findings in a way that key lessons may be derived and transferred between countries, contexts and patient-groups, where integrated care is delivered in order to provide insight into generalisability and build on existing evidence in this field.Methodology: To compare the different integrated care experiences, a mixed-methods approach has

An analytics approach to designing patient centered medical homes.

Science.gov (United States)

Ajorlou, Saeede; Shams, Issac; Yang, Kai

2015-03-01

Recently the patient centered medical home (PCMH) model has become a popular team based approach focused on delivering more streamlined care to patients. In current practices of medical homes, a clinical based prediction frame is recommended because it can help match the portfolio capacity of PCMH teams with the actual load generated by a set of patients. Without such balances in clinical supply and demand, issues such as excessive under and over utilization of physicians, long waiting time for receiving the appropriate treatment, and non-continuity of care will eliminate many advantages of the medical home strategy. In this paper, by using the hierarchical generalized linear model with multivariate responses, we develop a clinical workload prediction model for care portfolio demands in a Bayesian framework. The model allows for heterogeneous variances and unstructured covariance matrices for nested random effects that arise through complex hierarchical care systems. We show that using a multivariate approach substantially enhances the precision of workload predictions at both primary and non primary care levels. We also demonstrate that care demands depend not only on patient demographics but also on other utilization factors, such as length of stay. Our analyses of a recent data from Veteran Health Administration further indicate that risk adjustment for patient health conditions can considerably improve the prediction power of the model.

Path integral approach to eikonal and next-to-eikonal exponentiation

NARCIS (Netherlands)

Laenen, E.; Stavenga, G.; White, C.D.

2009-01-01

We approach the issue of exponentiation of soft gauge boson corrections to scattering amplitudes from a path integral point of view. We show that if one represents the amplitude as a first quantized path integral in a mixed coordinate-momentum space representation, a charged particle interacting

Performance improvement integration: a whole systems approach.

Science.gov (United States)

Page, C K

1999-02-01

Performance improvement integration in health care organizations is a challenge for health care leaders. Required for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), performance improvement (PI) can be designed as a sustainable model for performance to survive in a turbulent period. Central Baptist Hospital developed a model for PI that focused on strategy established by the leadership team, delineated responsibility through the organizational structure of shared governance, and accountability for outcomes evidenced through the organization's profitability. Such an approach integrated into the culture of the organization can produce positive financial margins, positive customer satisfaction, and commendations from the Joint Commission.

Electronic signature for medical documents--integration and evaluation of a public key infrastructure in hospitals.

Science.gov (United States)

Brandner, R; van der Haak, M; Hartmann, M; Haux, R; Schmücker, P

2002-01-01

Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use. Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established. Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were mean = 3.90; SD = 0.42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached mean = 3.91; SD = 0.47. On average, the discharge letters were completed 7.18 days earlier. The electronic signature is indispensable for the

Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine.

Science.gov (United States)

Greer, Pedro J; Brown, David R; Brewster, Luther G; Lage, Onelia G; Esposito, Karin F; Whisenant, Ebony B; Anderson, Frederick W; Castellanos, Natalie K; Stefano, Troy A; Rock, John A

2018-01-01

Despite medical advances, health disparities persist, resulting in medicine's renewed emphasis on the social determinants of health and calls for reform in medical education. The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school's community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program's engagement approach, logistics, and educational goals and structure. During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability. Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis.

Integrated ultrasound and gamma imaging probe for medical diagnosis

International Nuclear Information System (INIS)

Pani, R.; Pellegrini, R.; Cinti, M. N.; Polito, C.; Orlandi, C.; Fabbri, A.; Vincentis, G. De

2016-01-01

In the last few years, integrated multi-modality systems have been developed, aimed at improving the accuracy of medical diagnosis correlating information from different imaging techniques. In this contest, a novel dual modality probe is proposed, based on an ultrasound detector integrated with a small field of view single photon emission gamma camera. The probe, dedicated to visualize small organs or tissues located at short depths, performs dual modality images and permits to correlate morphological and functional information. The small field of view gamma camera consists of a continuous NaI:Tl scintillation crystal coupled with two multi-anode photomultiplier tubes. Both detectors were characterized in terms of position linearity and spatial resolution performances in order to guarantee the spatial correspondence between the ultrasound and the gamma images. Finally, dual-modality images of custom phantoms are obtained highlighting the good co-registration between ultrasound and gamma images, in terms of geometry and image processing, as a consequence of calibration procedures

Influence of open- and closed-book tests on medical students' learning approaches

NARCIS (Netherlands)

Heijne-Penninga, Marjolein; Kuks, Jan B. M.; Hofman, W. H. Adriaan; Cohen-Schotanus, Janke

2008-01-01

CONTEXT Two learning approaches are consistently distinguished in the literature: deep and surface learning. The deep learning approach is considered preferable. Open-book tests are expected to stimulate deep learning and to offer a possible way of handling the substantial growth in medical

Learning to walk before we run: what can medical education learn from the human body about integrated care?

Directory of Open Access Journals (Sweden)

Eron G. Manusov

2013-05-01

Full Text Available True integration requires a shift in all levels of medical and allied health education; one that emphasizes team learning, practicing, and evaluating from the beginning of each students' educational experience whether that is as physician, nurse, psychologist, or any other health profession.  Integration of healthcare services will not occur until medical education focuses, like the human body, on each system working inter-dependently and cohesively to maintain balance through continual change and adaptation.  The human body develops and maintains homeostasis by a process of communication: true integrated care relies on learned interprofessionality and ensures shared responsibility and practice.

Learning to walk before we run: what can medical education learn from the human body about integrated care.

Science.gov (United States)

Manusov, Eron G; Marlowe, Daniel P; Teasley, Deborah J

2013-04-01

True integration requires a shift in all levels of medical and allied health education; one that emphasizes team learning, practicing, and evaluating from the beginning of each students' educational experience whether that is as physician, nurse, psychologist, or any other health profession. Integration of healthcare services will not occur until medical education focuses, like the human body, on each system working inter-dependently and cohesively to maintain balance through continual change and adaptation. The human body develops and maintains homeostasis by a process of communication: true integrated care relies on learned interprofessionality and ensures shared responsibility and practice.

From Physical Process to Economic Cost - Integrated Approaches of Landslide Risk Assessment

Science.gov (United States)

Klose, M.; Damm, B.

2014-12-01

The nature of landslides is complex in many respects, with landslide hazard and impact being dependent on a variety of factors. This obviously requires an integrated assessment for fundamental understanding of landslide risk. Integrated risk assessment, according to the approach presented in this contribution, implies combining prediction of future landslide occurrence with analysis of landslide impact in the past. A critical step for assessing landslide risk in integrated perspective is to analyze what types of landslide damage affected people and property in which way and how people contributed and responded to these damage types. In integrated risk assessment, the focus is on systematic identification and monetization of landslide damage, and analytical tools that allow deriving economic costs from physical landslide processes are at the heart of this approach. The broad spectrum of landslide types and process mechanisms as well as nonlinearity between landslide magnitude, damage intensity, and direct costs are some main factors explaining recent challenges in risk assessment. The two prevailing approaches for assessing the impact of landslides in economic terms are cost survey (ex-post) and risk analysis (ex-ante). Both approaches are able to complement each other, but yet a combination of them has not been realized so far. It is common practice today to derive landslide risk without considering landslide process-based cause-effect relationships, since integrated concepts or new modeling tools expanding conventional methods are still widely missing. The approach introduced in this contribution is based on a systematic framework that combines cost survey and GIS-based tools for hazard or cost modeling with methods to assess interactions between land use practices and landslides in historical perspective. Fundamental understanding of landslide risk also requires knowledge about the economic and fiscal relevance of landslide losses, wherefore analysis of their

Reasoning methods in medical consultation systems: artificial intelligence approaches.

Science.gov (United States)

Shortliffe, E H

1984-01-01

It has been argued that the problem of medical diagnosis is fundamentally ill-structured, particularly during the early stages when the number of possible explanations for presenting complaints can be immense. This paper discusses the process of clinical hypothesis evocation, contrasts it with the structured decision making approaches used in traditional computer-based diagnostic systems, and briefly surveys the more open-ended reasoning methods that have been used in medical artificial intelligence (AI) programs. The additional complexity introduced when an advice system is designed to suggest management instead of (or in addition to) diagnosis is also emphasized. Example systems are discussed to illustrate the key concepts.

Integrating natural language processing expertise with patient safety event review committees to improve the analysis of medication events.

Science.gov (United States)

Fong, Allan; Harriott, Nicole; Walters, Donna M; Foley, Hanan; Morrissey, Richard; Ratwani, Raj R

2017-08-01

Many healthcare providers have implemented patient safety event reporting systems to better understand and improve patient safety. Reviewing and analyzing these reports is often time consuming and resource intensive because of both the quantity of reports and length of free-text descriptions in the reports. Natural language processing (NLP) experts collaborated with clinical experts on a patient safety committee to assist in the identification and analysis of medication related patient safety events. Different NLP algorithmic approaches were developed to identify four types of medication related patient safety events and the models were compared. Well performing NLP models were generated to categorize medication related events into pharmacy delivery delays, dispensing errors, Pyxis discrepancies, and prescriber errors with receiver operating characteristic areas under the curve of 0.96, 0.87, 0.96, and 0.81 respectively. We also found that modeling the brief without the resolution text generally improved model performance. These models were integrated into a dashboard visualization to support the patient safety committee review process. We demonstrate the capabilities of various NLP models and the use of two text inclusion strategies at categorizing medication related patient safety events. The NLP models and visualization could be used to improve the efficiency of patient safety event data review and analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

[Establishment and testing practice of an integrative medical pathway for clinical management of acute myocardial infarction].

Science.gov (United States)

Wang, Lei; Zhang, Min-zhou; Zhang, Jun

2011-01-01

To establish an integrative medical approach (IMA) for clinical management of acute myocardial infarction (AMI), and to test its efficacy. IMA was preliminarily established according to the guidelines and based on the Chinese medical therapy of benefiting vital qi and promoting blood circulation. And adopting non-synchronous queue design, AMI patients were assigned to the IMA group (71 cases) and the non-IMA group (70 cases), they were managed following or didn't follow the established IMA respectively. The total hospitalization time (THT), the ICU indwelling time (ICUD) and the total medical expenditure (TME) of patients were compared between groups. Moreover, for patients received primary PCI, the time for door-to-balloon (DTB) was compared in addition. Comparisons between groups showed that THT in the IMA group was shorter than that in the non-IMA group (9.80 +/- 5.62 days vs. 12.01 +/- 7. 35 days , P < 0.05); but the difference of TME between groups was insignificant. For those received PCT, the DTB in the IMA group was shorter than that in the non-IMA group in terms of DTB time (82.56 +/- 17.36 min vs. 119.19 +/- 30.88 min, P < 0.01), THT (9.69 +/- 5.59 vs. 13.34 +/- 7.49 days, P < 0.01) and TME. Practicing IMA for AMI, which was established based on Chinese medical therapy of benefiting vital qi and promoting blood circulation, could shorten the hospitalization time of patients, reduce the DTB time and TME in patients receiving primary PCI; fully displays its significance in hospital administration and quality control on AMI.

Assessing Saudi medical students learning approach using the revised two-factor study process questionnaire.

Science.gov (United States)

Shaik, Shaffi Ahamed; Almarzuqi, Ahmed; Almogheer, Rakan; Alharbi, Omar; Jalal, Abdulaziz; Alorainy, Majed

2017-08-17

To assess learning approaches of 1st, 2nd, and 3rd-year medical students by using revised two-factor study process questionnaire, and to assess reliability and validity of the questionnaire. This cross-sectional study was conducted at the College of Medicine, Riyadh, Saudi Arabia in 2014. The revised two-factor study process questionnaire (R-SPQ-2F) was completed by 610 medical students of both genders, from foundation (first year), central nervous system (second year), medicine and surgery (third year) courses. The study process was evaluated by computing mean scores of two research study approaches (deep & surface) using student's t-test and one-way analysis of variance. The internal consistency and construct validity of the questionnaire were assessed using Cronbach's α and factor analysis. The mean score of deep approach was significantly higher than the surface approach among participants(t (770) =7.83, p= 0.000) for the four courses. The mean scores of deep approach were significantly higher among participants with higher grade point average (F (2,768) =13.31, p=0.001) along with more number of study hours by participants (F (2,768) =20.08, p=0.001). The Cronbach's α-values of items at 0.70 indicate the good internal consistency of questionnaire used. Factor analysis confirms two factors (deep and surface approaches) of R-SPQ-2F. The deep approach to learning was the primary approach among 1st, 2nd and 3rd-year King Saud University medical students. This study confirms reliability and validity of the revised two-factor study process questionnaire. Medical educators could use the results of such studies to make required changes in the curriculum.

Biofilm eradication and prevention: a pharmaceutical approach to medical device infections

National Research Council Canada - National Science Library

Shunmugaperumal, Tamilvanan

2010-01-01

"Biofilm Eradication and Preventions presents the basics of biofilm formation on medical devices, diseases related to this formation, and approaches pharmaceutical researchers need to take to limit this problem...

An integrated approach towards future ballistic neck protection materials selection.

Science.gov (United States)

Breeze, John; Helliker, Mark; Carr, Debra J

2013-05-01

Ballistic protection for the neck has historically taken the form of collars attached to the ballistic vest (removable or fixed), but other approaches, including the development of prototypes incorporating ballistic material into the collar of an under body armour shirt, are now being investigated. Current neck collars incorporate the same ballistic protective fabrics as the soft armour of the remaining vest, reflecting how ballistic protective performance alone has historically been perceived as the most important property for neck protection. However, the neck has fundamental differences from the thorax in terms of anatomical vulnerability, flexibility and equipment integration, necessitating a separate solution from the thorax in terms of optimal materials selection. An integrated approach towards the selection of the most appropriate combination of materials to be used for each of the two potential designs of future neck protection has been developed. This approach requires evaluation of the properties of each potential material in addition to ballistic performance alone, including flexibility, mass, wear resistance and thermal burden. The aim of this article is to provide readers with an overview of this integrated approach towards ballistic materials selection and an update of its current progress in the development of future ballistic neck protection.

Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison.

Science.gov (United States)

Andraka-Christou, Barbara; Rager, Joshua B; Brown-Podgorski, Brittany; Silverman, Ross D; Watson, Dennis P

2018-05-22

In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature. We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy. In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions. This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision

Local Interaction Simulation Approach for Fault Detection in Medical Ultrasonic Transducers

Directory of Open Access Journals (Sweden)

Z. Hashemiyan

2015-01-01

Full Text Available A new approach is proposed for modelling medical ultrasonic transducers operating in air. The method is based on finite elements and the local interaction simulation approach. The latter leads to significant reductions of computational costs. Transmission and reception properties of the transducer are analysed using in-air reverberation patterns. The proposed approach can help to provide earlier detection of transducer faults and their identification, reducing the risk of misdiagnosis due to poor image quality.

Medical Dataset Classification: A Machine Learning Paradigm Integrating Particle Swarm Optimization with Extreme Learning Machine Classifier

Directory of Open Access Journals (Sweden)

C. V. Subbulakshmi

2015-01-01

Full Text Available Medical data classification is a prime data mining problem being discussed about for a decade that has attracted several researchers around the world. Most classifiers are designed so as to learn from the data itself using a training process, because complete expert knowledge to determine classifier parameters is impracticable. This paper proposes a hybrid methodology based on machine learning paradigm. This paradigm integrates the successful exploration mechanism called self-regulated learning capability of the particle swarm optimization (PSO algorithm with the extreme learning machine (ELM classifier. As a recent off-line learning method, ELM is a single-hidden layer feedforward neural network (FFNN, proved to be an excellent classifier with large number of hidden layer neurons. In this research, PSO is used to determine the optimum set of parameters for the ELM, thus reducing the number of hidden layer neurons, and it further improves the network generalization performance. The proposed method is experimented on five benchmarked datasets of the UCI Machine Learning Repository for handling medical dataset classification. Simulation results show that the proposed approach is able to achieve good generalization performance, compared to the results of other classifiers.

Expression of recombinant glycoproteins in mammalian cells: towards an integrative approach to structural biology.

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Aricescu, A Radu; Owens, Raymond J

2013-06-01

Mammalian cells are rapidly becoming the system of choice for the production of recombinant glycoproteins for structural biology applications. Their use has enabled the structural investigation of a whole new set of targets including large, multi-domain and highly glycosylated eukaryotic cell surface receptors and their supra-molecular assemblies. We summarize the technical advances that have been made in mammalian expression technology and highlight some of the structural insights that have been obtained using these methods. Looking forward, it is clear that mammalian cell expression will provide exciting and unique opportunities for an integrative approach to the structural study of proteins, especially of human origin and medically relevant, by bridging the gap between the purified state and the cellular context. Copyright © 2013 Elsevier Ltd. All rights reserved.

Integrated assessment of the global warming problem. A decision-analytical approach

International Nuclear Information System (INIS)

Van Lenthe, J.; Hendrickx, L.; Vlek, C.A.J.

1995-01-01

The project on the title subject aims at developing a policy-oriented methodology for the integrated assessment of the global warming problem. Decision analysis in general and influence diagrams in particular appear to constitute an appropriate integrated assessment methodology. The influence-diagram approach is illustrated at a preliminary integrated modeling of the global warming problem. In next stages of the research, attention will be shifted from the methodology of integrated assessment to the contents of integrated models. 4 figs., 5 refs

Evolution of the New Pathway curriculum at Harvard Medical School: the new integrated curriculum.

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Dienstag, Jules L

2011-01-01

In 1985, Harvard Medical School adopted a "New Pathway" curriculum, based on active, adult learning through problem-based, faculty-facilitated small-group tutorials designed to promote lifelong skills of self-directed learning. Despite the successful integration of clinically relevant material in basic science courses, the New Pathway goals were confined primarily to the preclinical years. In addition, the shifting balance in the delivery of health care from inpatient to ambulatory settings limited the richness of clinical education in clinical clerkships, creating obstacles for faculty in their traditional roles as teachers. In 2006, Harvard Medical School adopted a more integrated curriculum based on four principles that emerged after half a decade of self-reflection and planning: (1) integrate the teaching of basic/population science and clinical medicine throughout the entire student experience; (2) reestablish meaningful and intensive faculty-student interactions and reengage the faculty; (3) develop a new model of clinical education that offers longitudinal continuity of patient experience, cross-disciplinary curriculum, faculty mentoring, and student evaluation; and (4) provide opportunities for all students to pursue an in-depth, faculty-mentored scholarly project. These principles of our New Integrated Curriculum reflect our vision for a curriculum that fosters a partnership between students and faculty in the pursuit of scholarship and leadership.

The paradigm of consumer-driven and responsive supply chains: An integrated project approach

NARCIS (Netherlands)

Zimmermann, K.L.; Lans, van der I.A.

2009-01-01

This paper describes an integrated project approach that forms the basis of the studies on consumer-driven innovative and responsive supply chains in ISAFRUIT Pillar 1. This integrated approach leads to a wide range of indepth results on trends, preferences, and innovativeness of the European

Integrative medicine and patient-centered care.

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Maizes, Victoria; Rakel, David; Niemiec, Catherine

2009-01-01

Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies

Techniques of writing medical papers: a practical approach

International Nuclear Information System (INIS)

Im, Jung Gi

1991-01-01

Despite of diversity in their design and contents, it is well accepted that there are uniform requirements for manuscripts submitted to biomedical journals. Tactics for writing a medical paper could be refined through a check list approach in each part of the manuscripts. This review describes technical aspects of writing a paper in a manner of 'should' and 'should not' be contained in each part. Examples from the Journal of Korean Radiological Society are discussed

Medical knowledge packages and their integration into health-care information systems and the World Wide Web.

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Adlassnig, Klaus-Peter; Rappelsberger, Andrea

2008-01-01

Software-based medical knowledge packages (MKPs) are packages of highly structured medical knowledge that can be integrated into various health-care information systems or the World Wide Web. They have been established to provide different forms of clinical decision support such as textual interpretation of combinations of laboratory rest results, generating diagnostic hypotheses as well as confirmed and excluded diagnoses to support differential diagnosis in internal medicine, or for early identification and automatic monitoring of hospital-acquired infections. Technically, an MKP may consist of a number of inter-connected Arden Medical Logic Modules. Several MKPs have been integrated thus far into hospital, laboratory, and departmental information systems. This has resulted in useful and widely accepted software-based clinical decision support for the benefit of the patient, the physician, and the organization funding the health care system.

Identifying medication error chains from critical incident reports: a new analytic approach.

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Huckels-Baumgart, Saskia; Manser, Tanja

2014-10-01

Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety. © 2014, The American College of Clinical Pharmacology.

Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness.

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Bright, Cordellia E

Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.

Medical subdomain classification of clinical notes using a machine learning-based natural language processing approach.

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Weng, Wei-Hung; Wagholikar, Kavishwar B; McCray, Alexa T; Szolovits, Peter; Chueh, Henry C

2017-12-01

The medical subdomain of a clinical note, such as cardiology or neurology, is useful content-derived metadata for developing machine learning downstream applications. To classify the medical subdomain of a note accurately, we have constructed a machine learning-based natural language processing (NLP) pipeline and developed medical subdomain classifiers based on the content of the note. We constructed the pipeline using the clinical NLP system, clinical Text Analysis and Knowledge Extraction System (cTAKES), the Unified Medical Language System (UMLS) Metathesaurus, Semantic Network, and learning algorithms to extract features from two datasets - clinical notes from Integrating Data for Analysis, Anonymization, and Sharing (iDASH) data repository (n = 431) and Massachusetts General Hospital (MGH) (n = 91,237), and built medical subdomain classifiers with different combinations of data representation methods and supervised learning algorithms. We evaluated the performance of classifiers and their portability across the two datasets. The convolutional recurrent neural network with neural word embeddings trained-medical subdomain classifier yielded the best performance measurement on iDASH and MGH datasets with area under receiver operating characteristic curve (AUC) of 0.975 and 0.991, and F1 scores of 0.845 and 0.870, respectively. Considering better clinical interpretability, linear support vector machine-trained medical subdomain classifier using hybrid bag-of-words and clinically relevant UMLS concepts as the feature representation, with term frequency-inverse document frequency (tf-idf)-weighting, outperformed other shallow learning classifiers on iDASH and MGH datasets with AUC of 0.957 and 0.964, and F1 scores of 0.932 and 0.934 respectively. We trained classifiers on one dataset, applied to the other dataset and yielded the threshold of F1 score of 0.7 in classifiers for half of the medical subdomains we studied. Our study shows that a supervised

Towards an integrated approach to health and medicine in Africa

African Journals Online (AJOL)

2016-08-18

Aug 18, 2016 ... As such, a social approach to health-seeking behaviour questions how decisions ... In conclusion, the paper proposes that medicine and the humanities should engage seriously .... mental questions: What story does the integration or separation .... approach which has taken an interest in traditional healing.

Impact of telemonitoring approaches on integrated HIV and TB diagnosis and treatment interventions in sub-Saharan Africa: a scoping review

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Clarence S Yah

2017-03-01

Results: We found telemonitoring approaches as a convenient and sustained proxy-method of HIV and TB risk reduction strategies including early diagnosis and prompt quality clinical outcomes. This has shown to significantly contribute in decreasing health systems/patients cost, long waiting time in clinics, hospital visits, travels and time off/on from work. Conclusion: Telemonitoring/mhealth (electronic phone text/video/materials messaging adoption, integration, acceptability, access and uptake are crucial in monitoring and improving HIV and TB uptake, retention, adherence and coverage in both local and national interventions programs. Improved integrated HIV and TB telemonitoring sustainability hold great promises in health systems strengthening including patient early centered diagnosis and care delivery, uptake and retention in medications/ services and improvement of patients’ quality of life.

Modeling the economic impact of medication adherence in type 2 diabetes: a theoretical approach.

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Cobden, David S; Niessen, Louis W; Rutten, Frans Fh; Redekop, W Ken

2010-09-07

While strong correlations exist between medication adherence and health economic outcomes in type 2 diabetes, current economic analyses do not adequately consider them. We propose a new approach to incorporate adherence in cost-effectiveness analysis. We describe a theoretical approach to incorporating the effect of adherence when estimating the long-term costs and effectiveness of an antidiabetic medication. This approach was applied in a Markov model which includes common diabetic health states. We compared two treatments using hypothetical patient cohorts: injectable insulin (IDM) and oral (OAD) medications. Two analyses were performed, one which ignored adherence (analysis 1) and one which incorporated it (analysis 2). Results from the two analyses were then compared to explore the extent to which adherence may impact incremental cost-effectiveness ratios. In both analyses, IDM was more costly and more effective than OAD. When adherence was ignored, IDM generated an incremental cost-effectiveness of $12,097 per quality-adjusted life-year (QALY) gained versus OAD. Incorporation of adherence resulted in a slightly higher ratio ($16,241/QALY). This increase was primarily due to better adherence with OAD than with IDM, and the higher direct medical costs for IDM. Incorporating medication adherence into economic analyses can meaningfully influence the estimated cost-effectiveness of type 2 diabetes treatments, and should therefore be considered in health care decision-making. Future work on the impact of adherence on health economic outcomes, and validation of different approaches to modeling adherence, is warranted.

A multimetric approach for predicting the ecological integrity of New Zealand streams

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Clapcott J.E.

2014-01-01

Full Text Available Integrating multiple measures of stream health into a combined metric can provide a holistic assessment of the ecological integrity of a stream. The aim of this study was to develop a multimetric index (MMI of stream integrity based on predictive modelling of national data sets of water quality, macroinvertebrates, fish and ecosystem process metrics. We used a boosted regression tree approach to calculate an observed/expected score for each metric prior to combining metrics in a MMI based on data availability and the strength of predictive models. The resulting MMI provides a geographically meaningful prediction of the ecological integrity of rivers in New Zealand, but identifies limitations in data and approach, providing focus for ongoing research.

Undergraduate hematology – a more integrated approach

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Di Carlofelice MA

2016-11-01

Full Text Available Matteo A Di Carlofelice,* Jack FT Cope*Faculty of Medicine, Imperial College London, London, UK*These authors contributed equally to this workAs fellow medical students we read with great interest the article by Mandan et al1 proposing a dedicated hematology rotation. The authors highlight a gap in clinical hematology teaching, particularly compared to “conventional rotations”.1 Their suggestion has merits and we agree with most of the points raised; however, propose instead for us to build on current teaching as opposed to establishing a new rotation.The integration of theoretical and practical learning was concluded to be beneficial to both teacher and student by Wrenn and Wrenn.2 In the original article it is mentioned that “clinical experience allows students to comprehend and apply this knowledge in practice, enabling the all-important integration of their learning”.1 As we agree that hematology overlaps with other specialties and therefore requires a thorough understanding, we value how a clinical attachment would be useful to solidify lecture-based teaching.View the original paper by Mandan et al.

Integration of case study approach, project design and computer ...

African Journals Online (AJOL)

Integration of case study approach, project design and computer modeling in managerial accounting education ... Journal of Fundamental and Applied Sciences ... in the Laboratory of Management Accounting and Controlling Systems at the ...

Integration of Evidence Base into a Probabilistic Risk Assessment

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Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

Implementing Digital Storytelling as a Technology Integration Approach with Primary School Children

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Nuala Sweeney-Burt

2014-06-01

Full Text Available Irish educational policy acknowledges the importance of integrating technology meaningfully into teaching and learning at the primary level. Much remains to be done, however, in terms of developing, practically implementing and evaluating the use of technology in the Irish primary classroom. This paper describes a study on the use of a structured approach to digital storytelling as a tool for meaningful technology integration with children at primary level. In this study, the researcher developed a structured approach for implementing digital storytelling with primary school children, and collaborated with a class teacher in an Irish primary school to prepare to implement the approach. Multiple qualitative methods were used to evaluate the implementation, including interviews with the teacher, classroom observation, and focus group interviews with participating children. The results suggested that this structured approach to digital storytelling has the potential to be used successfully as a meaningful technology integration approach with this cohort. The findings also explored implications for the implementation of digital storytelling at primary level, and identified aspects on which further research should be undertaken to enhance and extend the approach that was used.

Graph-based sequence annotation using a data integration approach.

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Pesch, Robert; Lysenko, Artem; Hindle, Matthew; Hassani-Pak, Keywan; Thiele, Ralf; Rawlings, Christopher; Köhler, Jacob; Taubert, Jan

2008-08-25

The automated annotation of data from high throughput sequencing and genomics experiments is a significant challenge for bioinformatics. Most current approaches rely on sequential pipelines of gene finding and gene function prediction methods that annotate a gene with information from different reference data sources. Each function prediction method contributes evidence supporting a functional assignment. Such approaches generally ignore the links between the information in the reference datasets. These links, however, are valuable for assessing the plausibility of a function assignment and can be used to evaluate the confidence in a prediction. We are working towards a novel annotation system that uses the network of information supporting the function assignment to enrich the annotation process for use by expert curators and predicting the function of previously unannotated genes. In this paper we describe our success in the first stages of this development. We present the data integration steps that are needed to create the core database of integrated reference databases (UniProt, PFAM, PDB, GO and the pathway database Ara-Cyc) which has been established in the ONDEX data integration system. We also present a comparison between different methods for integration of GO terms as part of the function assignment pipeline and discuss the consequences of this analysis for improving the accuracy of gene function annotation. The methods and algorithms presented in this publication are an integral part of the ONDEX system which is freely available from http://ondex.sf.net/.

[Integrative approach in the psychotherapy of borderline personality disorder].

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Kuritárné Szabó, Ildikó

2012-01-01

In the last 20 years six psychotherapy methods have been developed specifically for borderline personality disorder. Solid RCT evidences suggests the efficacy of all the methods. Roughly equivalent improvement was obtained from the different types of psychotherapies. Today we have reached a new phase of the borderline "psychotherapy boom", the integrative approach. According to the integrative treatment advocates we should not choose among these effective treatments but we can incorporate in the therapy all the components that work. The integrative approach uses general factors common to all effective therapies, combined with specific treatment techniques taken from different therapies in order to treat the given patient's psychopathology. These common factors are: coherent framework; attention to strategies for building strong positive alliance and maintaining patient motivation; creating a safe and structured therapeutic environment; clear treatment frame; transparency of the goals and roles; focus upon presenting problems; higher level therapeutic activity; here-and-now focus; and facilitating self-reflection. Treatment focuses on change while maintaining a validating and supportive stance. General strategies can be supplemented by more specific techniques such as cognitive-behavioral interventions for reducing maladaptive behavior, training for developing emotion regulation skills and interpersonal skills coming from dialectical behavior therapy. Methods drawn from psychodynamic approaches can be used for the modification of underlying interpersonal cognitive-emotional schemas.

Joint principles: Integrating behavioral health care into the patient-centered medical home.

Science.gov (United States)

2014-06-01

The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. The Joint Principles of the PCMH, formulated and endorsed in February 2007, are sound and describe the ideal toward which we aspire. However, there is an element running implicitly through these joint principles that is difficult to achieve yet indispensable to the success of the entire PCMH concept. The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element, and retrofitting will be much more difficult than prospectively integrating into the original design of the PCMH. Therefore we offer a complementary set of joint principles that recognizes the centrality of behavioral health care as part of the PCMH. This document follows the order and language of the original joint principles while emphasizing what needs to be addressed to insure incorporation of the essential behavioral elements. It is intended to supplement and not replace the original Joint Principles document, which still stands.

Development and initial feasibility of an organizational measure of behavioral health integration in medical care settings.

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McGovern, Mark P; Urada, Darren; Lambert-Harris, Chantal; Sullivan, Steven T; Mazade, Noel A

2012-12-01

In the advent of health care reform, models are sought to integrate behavioral health and routine medical care services. Historically, the behavioral health specialty has not itself been integrated, but instead bifurcated by substance use and mental health across treatment systems, care providers and even research. With the present opportunity to transform the health care delivery system, it is incumbent upon policymakers, researchers and clinicians to avoid repeating this historical error, and provide integrated behavioral health services in medical contexts. An organizational measure designed to assess this capacity is described: the Dual Diagnosis Capability in Health Care Settings (DDCHCS). The DDCHCS was used to assess a sample of federally-qualified health centers (N=13) on the degree of behavioral health integration. The measure was found to be feasible and sensitive to detecting variation in integrated behavioral health services capacity. Three of the 13 agencies were dual diagnosis capable, with significant variation in DDCHCS dimensions measuring staffing, treatment practices and program milieu. In general, mental health services were more integrated than substance use. Future research should consider a revised version of the measure, a larger and more representative sample, and linking organizational capacity with patient outcomes. Copyright © 2012. Published by Elsevier Inc.

Cross-cultural medical education in the United States: key principles and experiences.

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Betancourt, Joseph R; Cervantes, Marina C

2009-09-01

The field of cross-cultural care focuses on the ability to communicate effectively and provide quality health care to patients from diverse sociocultural backgrounds. In recent years, medical schools in the United States have increasingly recognized the growing importance of incorporating cross-cultural curricula into medical education. Cross-cultural medical education in the United States has emerged for four reasons: (1) the need for providers to have the skills to care for a diverse patient population; (2) the link between effective communication and health outcomes; (3) the presence of racial/ethnic disparities that are, in part, due to poor communication across cultures; and (4) medical school accreditation requirements. There are three major approaches to cross-cultural education: (1) the cultural sensitivity/awareness approach that focuses on attitudes; (2) the multicultural/categorical approach that focuses on knowledge; and (3) the cross-cultural approach that focuses on skills. The patient-based approach to cross-cultural care combines these three concepts into a framework that can be used to care for any patient, anytime, anywhere. Ultimately, if cross-cultural medical education is to evolve, students must believe it is important and understand that the categorical approach can lead to stereotyping; it should be taught using patient cases and highlighting clinical applications; it should be embedded in a longitudinal, developmentally appropriate fashion; and it should be integrated into the larger curriculum whenever possible. At the Harvard Medical School, we have tried to apply all of these lessons to our work, and we have started to develop a strategic integration process where we try to raise awareness, impart knowledge, and teach cross-cultural skills over the 4 years of schooling.

Can Mindfulness Training Improve Medication Adherence? Integrative Review of the Current Evidence and Proposed Conceptual Model.

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Salmoirago-Blotcher, Elena; Carey, Michael P

Medication adherence is a complex, multi-determined behavior that is often influenced by system- (e.g., cost), drug- (e.g., regimen complexity), and patient-related (e.g., depression) factors. System-level approaches (e.g., making medications more affordable) are critically important but do not address patient-level factors that can undermine adherence. In this paper, we identify patient-level determinants of non-adherence and discuss whether mindfulness-training approaches that target these determinants can help to improve adherence to medical treatment. We highlight two chronic medical conditions (viz., heart failure and HIV) where poor adherence is a significant concern, and examine the evidence regarding the use of mindfulness interventions to improve medication adherence in these two conditions. We also discuss the theoretical underpinnings of mindfulness training with respect to medication adherence, and conclude by suggesting directions for future research. Copyright © 2018 Elsevier Inc. All rights reserved.

Interprofessional education in the integrated medical education and health care system: A content analysis

Directory of Open Access Journals (Sweden)

MAHBOOBEH KHABAZ MAFINEJAD

2016-07-01

Full Text Available Introduction: The current literature supports the inclusion of inter-professional education in healthcare education. Changes in the structure and nature of the integrated medical education and healthcare system provide some opportunities for interprofessional education among various professions. This study is an attempt to determine the perceptions of students and faculty members about interprofessional education in the context of the medical education and healthcare system. Methods: This qualitative content analysis study was conducted using purposeful sampling in 2012. Thirteen semi-structured interviews were conducted with 6 faculty members and 7 students at Tehran and Iran Universities of Medical Sciences. Data collection and analysis were concurrent. Results: Data analysis revealed four categories and nine subcategories. The categories emerging from individual interviews were “educational structure”, “mediating factors”, “conceptual understanding”, and “professional identity”. These categories are explained using quotes derived from the data. Conclusion: Matching the existing educational context and structure with IPE through removing barriers and planning to prepare the required resources and facilities can solve numerous problems associated with implementation and design of interprofessional training programs in Iran. In this way, promoting the development of a cooperative rather than a competitive learning and working atmosphere should be taken into account. The present findings will assist the managers and policy makers to consider IPE as a useful strategy in the integrated medical education and healthcare system.

How lead consultants approach educational change in postgraduate medical education.

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Fokkema, Joanne P I; Westerman, Michiel; Teunissen, Pim W; van der Lee, Nadine; Scherpbier, Albert J J A; van der Vleuten, Cees P M; Dörr, P Joep; Scheele, Fedde

2012-04-01

  Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead consultants approach educational change.   This study was conducted to explore lead consultants' approaches to educational change in specialty training and factors influencing these approaches.   From an interpretative constructivist perspective, we conducted a qualitative exploratory study using semi-structured interviews with a purposive sample of 16 lead consultants in the Netherlands between August 2010 and February 2011. The study design was based on the research questions and notions from corporate business and social psychology about the roles of change managers. Interview transcripts were analysed thematically using template analysis.   The lead consultants described change processes with different stages, including cause, development of content, and the execution and evaluation of change, and used individual change strategies consisting of elements such as ideas, intentions and behaviour. Communication is necessary to the forming of a strategy and the implementation of change, but the nature of communication is influenced by the strategy in use. Lead consultants differed in their degree of awareness of the strategies they used. Factors influencing approaches to change were: knowledge, ideas and beliefs about change; level of reflection; task interpretation; personal style, and department culture.   Most lead consultants showed limited awareness of their own approaches to change. This can lead them to adopt a rigid approach, whereas the ability to adapt strategies to circumstances is considered important to effective change management. Interventions and research should be aimed at enhancing the awareness of lead consultants of approaches to change in PGME. �

Cross-cultural medical education: conceptual approaches and frameworks for evaluation.

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Betancourt, Joseph R

2003-06-01

Given that understanding the sociocultural dimensions underlying a patient's health values, beliefs, and behaviors is critical to a successful clinical encounter, cross-cultural curricula have been incorporated into undergraduate medical education. The goal of these curricula is to prepare students to care for patients from diverse social and cultural backgrounds, and to recognize and appropriately address racial, cultural, and gender biases in health care delivery. Despite progress in the field of cross-cultural medical education, several challenges exist. Foremost among these is the need to develop strategies to evaluate the impact of these curricular interventions. This article provides conceptual approaches for cross-cultural medical education, and describes a framework for student evaluation that focuses on strategies to assess attitudes, knowledge, and skills, and the impact of curricular interventions on health outcomes.

A new data integration approach for AutoCAD and GIS

Science.gov (United States)

Ye, Hongmei; Li, Yuhong; Wang, Cheng; Li, Lijun

2006-10-01

GIS has its advantages both on spatial data analysis and management, particularly on the geometric and attributive information management, which has also attracted lots attentions among researchers around world. AutoCAD plays more and more important roles as one of the main data sources of GIS. Various work and achievements can be found in the related literature. However, the conventional data integration from AutoCAD to GIS is time-consuming, which also can cause the information loss both in the geometric aspects and the attributive aspects for a large system. It is necessary and urgent to sort out new approach and algorithm for the efficient high-quality data integration. In this paper, a novel data integration approach from AutoCAD to GIS will be introduced based on the spatial data mining technique through the data structure analysis both in the AutoCAD and GIS. A practicable algorithm for the data conversion from CAD to GIS will be given as well. By a designed evaluation scheme, the accuracy of the conversion both in the geometric and the attributive information will be demonstrated. Finally, the validity and feasibility of the new approach will be shown by an experimental analysis.

Interventions to promote an integrated approach to public health problems : an application to childhood obesity

NARCIS (Netherlands)

Hendriks, Anna-Marie; Gubbels, Jessica S; De Vries, Nanne K.; Seidell, Jaap C; Kremers, Stef P J; Jansen, Maria W J

2012-01-01

Experts stress the need to bring the childhood obesity epidemic under control by means of an integrated approach. The implementation of such an approach requires the development of integrated enabling policies on public health by local governments. A prerequisite for developing such integrated

Group processes in medical education: learning from social identity theory.

Science.gov (United States)

Burford, Bryan

2012-02-01

The clinical workplace in which doctors learn involves many social groups, including representatives of different professions, clinical specialties and workplace teams. This paper suggests that medical education research does not currently take full account of the effects of group membership, and describes a theoretical approach from social psychology, the social identity approach, which allows those effects to be explored. The social identity approach has a long history in social psychology and provides an integrated account of group processes, from the adoption of group identity through a process of self-categorisation, to the biases and conflicts between groups. This paper outlines key elements of this theoretical approach and illustrates their relevance to medical education. The relevance of the social identity approach is illustrated with reference to a number of areas of medical education. The paper shows how research questions in medical education may be usefully reframed in terms of social identity in ways that allow a deeper exploration of the psychological processes involved. Professional identity and professionalism may be viewed in terms of self-categorisation rather than simply attainment; the salience of different identities may be considered as influences on teamwork and interprofessional learning, and issues in communication and assessment may be considered in terms of intergroup biases. Social identity theory provides a powerful framework with which to consider many areas of medical education. It allows disparate influences on, and consequences of, group membership to be considered as part of an integrated system, and allows assumptions, such as about the nature of professional identity and interprofessional tensions, to be made explicit in the design of research studies. This power to question assumptions and develop deeper and more meaningful research questions may be increasingly relevant as the nature and role of the medical profession change

DOE systems approach and integration

International Nuclear Information System (INIS)

Logan, J.A.

1987-01-01

Six sites are now disposing of most of DOE's currently generated waste. These are: Hanford, Idaho National Engineering Laboratory, Los Alamos National Laboratory, the Nevada Test Site, Oak Ridge, and Savannah River. Within DOE, experience with disposal of solid LLW has been that arid site disposal facilities (first four) appear to have performed well, while humid site disposal facilities (last two) have experienced some waste migration. DOE's intent, of course, is to operate all its waste disposal facilities so that public health and safety are not adversely affected. To ensure that this continues to be the case, activities are underway to increase use of waste form stabilization and engineered barriers where appropriate. For the sake of overall economy, these measures are to be applied as and where needed, through use of the systems approach. In this paper the author discusses two topics: the system approach, which DOE has decided to use for resolving waste disposal problems in the management of DOE's low-level wastes; and DOE's intended integration of activities underway at the waste management systems throughout DOE facilities. 2 figures

Babenko’s Approach to Abel’s Integral Equations

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Chenkuan Li

2018-03-01

Full Text Available The goal of this paper is to investigate the following Abel’s integral equation of the second kind: y ( t + λ Γ ( α ∫ 0 t ( t − τ α − 1 y ( τ d τ = f ( t , ( t > 0 and its variants by fractional calculus. Applying Babenko’s approach and fractional integrals, we provide a general method for solving Abel’s integral equation and others with a demonstration of different types of examples by showing convergence of series. In particular, we extend this equation to a distributional space for any arbitrary α ∈ R by fractional operations of generalized functions for the first time and obtain several new and interesting results that cannot be realized in the classical sense or by the Laplace transform.

Designing to target cost: one approach to design/construction integration

DEFF Research Database (Denmark)

Jørgensen, Bo

2005-01-01

One approach to a more integrated construction delivery process is the concept of ‘designing to target cost’ of which the first examples of application within a lean construction framework have recently been seen. This paper introduces the main principles of the design to target cost method...... and discusses the applicability of this approach to construction. The low degree of organizational and technical continuity from one construction project to the next limits the applicability of the design for target cost approach when compared to its origin in product development of mass manufactured artefacts....... It can be argued that design to target cost may also provide a frame for developing the supply chain towards better coordination and collaboration. Thus methods of design to target cost may serve to facilitate the development of a more integrated supply chain....

Integral equation approach to time-dependent kinematic dynamos in finite domains

International Nuclear Information System (INIS)

Xu Mingtian; Stefani, Frank; Gerbeth, Gunter

2004-01-01

The homogeneous dynamo effect is at the root of cosmic magnetic field generation. With only a very few exceptions, the numerical treatment of homogeneous dynamos is carried out in the framework of the differential equation approach. The present paper tries to facilitate the use of integral equations in dynamo research. Apart from the pedagogical value to illustrate dynamo action within the well-known picture of the Biot-Savart law, the integral equation approach has a number of practical advantages. The first advantage is its proven numerical robustness and stability. The second and perhaps most important advantage is its applicability to dynamos in arbitrary geometries. The third advantage is its intimate connection to inverse problems relevant not only for dynamos but also for technical applications of magnetohydrodynamics. The paper provides the first general formulation and application of the integral equation approach to time-dependent kinematic dynamos, with stationary dynamo sources, in finite domains. The time dependence is restricted to the magnetic field, whereas the velocity or corresponding mean-field sources of dynamo action are supposed to be stationary. For the spherically symmetric α 2 dynamo model it is shown how the general formulation is reduced to a coupled system of two radial integral equations for the defining scalars of the poloidal and toroidal field components. The integral equation formulation for spherical dynamos with general stationary velocity fields is also derived. Two numerical examples - the α 2 dynamo model with radially varying α and the Bullard-Gellman model - illustrate the equivalence of the approach with the usual differential equation method. The main advantage of the method is exemplified by the treatment of an α 2 dynamo in rectangular domains

HTC Vive MeVisLab integration via OpenVR for medical applications.

Science.gov (United States)

Egger, Jan; Gall, Markus; Wallner, Jürgen; Boechat, Pedro; Hann, Alexander; Li, Xing; Chen, Xiaojun; Schmalstieg, Dieter

2017-01-01

Virtual Reality, an immersive technology that replicates an environment via computer-simulated reality, gets a lot of attention in the entertainment industry. However, VR has also great potential in other areas, like the medical domain, Examples are intervention planning, training and simulation. This is especially of use in medical operations, where an aesthetic outcome is important, like for facial surgeries. Alas, importing medical data into Virtual Reality devices is not necessarily trivial, in particular, when a direct connection to a proprietary application is desired. Moreover, most researcher do not build their medical applications from scratch, but rather leverage platforms like MeVisLab, MITK, OsiriX or 3D Slicer. These platforms have in common that they use libraries like ITK and VTK, and provide a convenient graphical interface. However, ITK and VTK do not support Virtual Reality directly. In this study, the usage of a Virtual Reality device for medical data under the MeVisLab platform is presented. The OpenVR library is integrated into the MeVisLab platform, allowing a direct and uncomplicated usage of the head mounted display HTC Vive inside the MeVisLab platform. Medical data coming from other MeVisLab modules can directly be connected per drag-and-drop to the Virtual Reality module, rendering the data inside the HTC Vive for immersive virtual reality inspection.

HTC Vive MeVisLab integration via OpenVR for medical applications.

Directory of Open Access Journals (Sweden)

Jan Egger

Full Text Available Virtual Reality, an immersive technology that replicates an environment via computer-simulated reality, gets a lot of attention in the entertainment industry. However, VR has also great potential in other areas, like the medical domain, Examples are intervention planning, training and simulation. This is especially of use in medical operations, where an aesthetic outcome is important, like for facial surgeries. Alas, importing medical data into Virtual Reality devices is not necessarily trivial, in particular, when a direct connection to a proprietary application is desired. Moreover, most researcher do not build their medical applications from scratch, but rather leverage platforms like MeVisLab, MITK, OsiriX or 3D Slicer. These platforms have in common that they use libraries like ITK and VTK, and provide a convenient graphical interface. However, ITK and VTK do not support Virtual Reality directly. In this study, the usage of a Virtual Reality device for medical data under the MeVisLab platform is presented. The OpenVR library is integrated into the MeVisLab platform, allowing a direct and uncomplicated usage of the head mounted display HTC Vive inside the MeVisLab platform. Medical data coming from other MeVisLab modules can directly be connected per drag-and-drop to the Virtual Reality module, rendering the data inside the HTC Vive for immersive virtual reality inspection.

Innovations in higher medical education

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Popkov V.M.

2014-03-01

Full Text Available The article is devoted to the innovations in the higher medical education. Particular attention in this sphere is paid to the detailed analysis of the subject as a mechanism of cognition and psycho-emotional aspect. It should be noticed that the development of the university education demands the integration of functional systems to study the general medicine and the art of healing. In conclusion it has been found out that the new methodological approach is necessary to bring the teacher closer to the subject particularly to integrate the relation of the opposites.

Managerial process improvement: a lean approach to eliminating medication delivery.

Science.gov (United States)

Hussain, Aftab; Stewart, LaShonda M; Rivers, Patrick A; Munchus, George

2015-01-01

Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

Integrative approaches to childhood constipation and encopresis.

Science.gov (United States)

Culbert, Timothy P; Banez, Gerard A

2007-12-01

Constipation and encopresis (fecal soiling) are common childhood disorders that may lead to significant functional impairment. The etiology and course of constipation and encopresis are increasingly conceptualized from a broad biopsychosocial perspective, and therefore a holistic approach to assessment and treatment is indicated. Many children experience symptoms of chronic constipation and/or encopresis that are only partially responsive to conventional medical therapy. Complementary/alternative therapies can often help in the treatment of constipation/encopresis and are well accepted by patients and families.

Monetary policy and financial (in)stability : An integrated micro-macro approach

NARCIS (Netherlands)

De Graeve, F.; Kick, T.; Koetter, M.; DeGraeve, F.

Evidence on central banks' twin objective, monetary and financial stability, is scarce. We suggest an integrated micro macro approach with two core virtues. First, we measure financial stability directly at the bank level as the probability of distress. Second, we integrate a microeconomic hazard

Designing a strategic plan development approach for integrated area development projects

NARCIS (Netherlands)

de Kort, Inge

2009-01-01

Increasingly, it has become evident that spatial problems can no longer be resolved in isolation, but should be solved in conjunction with other development-related issues. Interest in integrated area development is growing, and a more integrated planning approach is desired. In this design-based

Integrating cell biology and proteomic approaches in plants.

Science.gov (United States)

Takáč, Tomáš; Šamajová, Olga; Šamaj, Jozef

2017-10-03

Significant improvements of protein extraction, separation, mass spectrometry and bioinformatics nurtured advancements of proteomics during the past years. The usefulness of proteomics in the investigation of biological problems can be enhanced by integration with other experimental methods from cell biology, genetics, biochemistry, pharmacology, molecular biology and other omics approaches including transcriptomics and metabolomics. This review aims to summarize current trends integrating cell biology and proteomics in plant science. Cell biology approaches are most frequently used in proteomic studies investigating subcellular and developmental proteomes, however, they were also employed in proteomic studies exploring abiotic and biotic stress responses, vesicular transport, cytoskeleton and protein posttranslational modifications. They are used either for detailed cellular or ultrastructural characterization of the object subjected to proteomic study, validation of proteomic results or to expand proteomic data. In this respect, a broad spectrum of methods is employed to support proteomic studies including ultrastructural electron microscopy studies, histochemical staining, immunochemical localization, in vivo imaging of fluorescently tagged proteins and visualization of protein-protein interactions. Thus, cell biological observations on fixed or living cell compartments, cells, tissues and organs are feasible, and in some cases fundamental for the validation and complementation of proteomic data. Validation of proteomic data by independent experimental methods requires development of new complementary approaches. Benefits of cell biology methods and techniques are not sufficiently highlighted in current proteomic studies. This encouraged us to review most popular cell biology methods used in proteomic studies and to evaluate their relevance and potential for proteomic data validation and enrichment of purely proteomic analyses. We also provide examples of

Development of an integral assessment approach of health status in patients with obstructive airway diseases: the CORONA study

Directory of Open Access Journals (Sweden)